Drug
Dose Range
Nicotine Patch
Initial dose depends on
smoking hx: 7-21 mg daily
Nicotine Gum
Initial dose depends on
smoking hx; 2-4 mg q1-8hrs
Nicotine Lozenge
Initial dose depends on
smoking hx; 2-4 mg; max of
20/day
24-64 mg/day total daily
dosing
Nicotine Inhaler
Nicotine Nasal Spray
8-40 mg/day total daily dose
Bupropion SR
Start 1-2 weeks before
quitting
Titrate up to 150 mg twice a
day
Start 1 week before quitting
Titrate up to 1 mg twice a
day
Varenicline
Duration
Comments/Monitoring
Parameters
6 weeks & taper down Heart rate and blood pressure
over time
monitored periodically while on
therapy
12 weeks & taper down Heart rate and blood pressure
over time
monitored periodically while on
therapy
12 weeks
Heart rate and blood pressure
monitored periodically while on
therapy
3-6 months & taper
Heart rate and blood pressure
down over time
monitored periodically while on
therapy
14 weeks & taper down Heart rate and blood pressure
over time
monitored periodically while on
therapy
3-6 months
May require lower dose initially in
elderly; HTN can occur in pts on
bupropion & nicotine patch
3-6 months
Research
Stead, et al., Nicotine replacement therapy for smoking cessation (Review), The
Cochran Collaboration, Issue 11, 2012.
Shiffman, et al., Assigning dose of nicotine gum by time to first cigarette,
Nicotine & Tobacco Research, Vol. 15, Feb. 2013.
Ebbert, et al., A randomized clinical trial of nicotine lozenge for smokeless
tobacco use, Nicotine & Tobacco Research, Vol. 11, Dec. 2009.
Stapleton & Sutherland, Treating heavy smokers in primary care with the
nicotine nasal spray: randomized placebo-controlled trial, Addiction, Vo. 106,
2011.
Cinciripini, et al., Effects of varenicline & bupropion sustained-release use plus
intensive smoking cessation counseling on prolonged abstinence from smoking
& on depression, negative affect, & other symptoms of nicotine withdrawal,
JAMA Psychiatry, Vol. 70, 2013.
Tonstad, et al., Psychiatric adverse events in randomized double-blind, placebocontrolled clinical trials of varenicline, Drug Safety, Vol. 33, 2010.
If CrCl< 30 ml/min use 0.5 mg
daily; monitor renal function esp.
in elderly; nausea, HA & insomnia
are dose dependent effects
Clonidine
Titrate to response: 0.2-0.75 6-12 months
Consider lower dose in elderly;
Not FDA approved for smoking cessation
mg/day
monitor baseline electrolytes, lipid
profile, renal function, uric acid,
CBC and blood pressure
Nortriptyline
Titrate up to 75-100 mg
6-12 months
Dry mouth, blurred vision,
Not FDA approved for smoking cessation
daily
constipation are dose dependent
adverse effects
Adolescent studies: Botello-Harbaum, et al., Nicotine replacement therapy use among adolescent smokers seeking cessation treatment, Ethnicity & Disease, Vol. 20, Spring 2010. Bailey, et al.,
Efficacy & tolerability of pharmacotherapies to aid smoking cessation in adolescents, NIH Public Access, Paediatric Drugs, Vol. 14, April, 2012.
Doering & Li, Substance-Related Disorders II: Alcohol, Nicotine & Caffeine, Pharmacotherapy, A Pathophysiologic Approach, 9th edition, 2014.