Nicotine Replacement Therapy
A S U M M A RY F O R H E A L T H C A R E P R O F E S S I O N A L S
NRT is an effective aid for smoking cessation. It replaces some of the nicotine that a smoker would have otherwise got from
their tobacco smoke, but less rapidly. It roughly doubles the chances of stopping smoking long-term1 by reducing withdrawal
symptoms and the severity of urges to smoke.
Things to tell your pa tients
1.
2.
3.
NRT is not a magic cure, but it will make quitting easier.
Using NRT is not like smoking. NRT is safe to use in people who smoke.
Use enough of it and for at least 8 weeks.
4. The oral products don’t taste pleasant initially, but people will get used to the taste in a short time.
PATCH (24-HOUR)
strengthsa
PRODUCT
INFORMATION
Three
(21 mg, 14
mg, and 7 mg).
GUM
LOZENGE
Two strengths (4 mg and 2
mg).
Two strengths (2 mg and 1
mg).
A GUIDE TO PRODUCT CHOICE
 Smokers of 10 or more cigarettes per day: recommend patch 21 mg/24 hr and/or gum or
lozenge

PRODUCT AND
DOSAGE b
Smokers of fewer than 10 cigarettes per day: recommend gum or lozenge.
If an oral product cannot be tolerated then start with a 14 mg patch/day, and review the dose
within a week.
A GUIDE TO DOSAGE:
Use time to first cigarette to guide dose of gum and lozenge

If within an hour of waking use 4mg gum or 2mg lozenge

If after an hour of waking use 2mg gum or 1 mg lozenge
The dose of NRT can be increased if the user has inadequate relief of withdrawal symptoms (e.g.,
urges to smoke, irritability, restlessness).c All products should be used for 8-12 weeks, or longer for
some people. NRT can be used in all people who smoke. d,e,f,g
INSTRUCTIONS
FOR CORRECT
USE
PATCH
GUM
LOZENGE
Apply patch to clean, dry and
hairless skin. Remove old and
apply new patch daily,
alternating sites. Some redness
under the patch may occur –
this is normal. If sleep
disturbance is experienced the
patch can be removed
overnight.
Bite to release the peppery
taste and then rest in the side
of the mouth (between cheek
and gums). Chew again when
the taste starts to fade. Chew
for about 30 minutes then
discard.
Suck to release the peppery
taste, and then rest in the side
of the mouth (between cheek
and gum). Suck again when
the taste starts to fade.
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Suck for about 30 minutes then
discard.
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NOTES ABOUT NRT:
a.
b.
c.
d.
e.
f.
g.
Lower strength patches are generally used only for weaning. Their use is not strictly necessary.
Note that these recommended doses differ from those listed on the product packaging. These recommendations simplify NRT dosage and try to
ensure that people are getting enough nicotine replacement.
Most smokers don’t use enough NRT, but rarely some have too much and then feel nauseated. If someone feels sick using NRT they should
reduce the frequency or dose of the product.
NRT can be used by pregnant or breastfeeding women if they would otherwise continue to smoke. Do a risk-benefit assessment – can she quit
without NRT? If not, NRT is safer than smoking.
NRT is safe to use in people with cardiovascular disease. No dosage adjustment is needed. If the client has had a heart attack, stroke, or
severe angina in the past two weeks, and you are not their primary health care practitioner, recommend they discuss using NRT with their GP.
NRT can be used in adolescents (aged 12 and over). Use the product best suited to their needs.
There are no drug interactions with NRT. However, the doses of some medicines (e.g., some psychiatric medicines) may need a dosage
adjustment when people stop smoking.
Additional Information
 New Zealand Smoking Cessation Guidelines: http://www.moh.govt.nz/moh.nsf/indexmh/nz-smoking-cessation-guidelines
 Best Practice Update on Smoking Cessation:
http://www.bpac.org.nz/magazine/2010/december/smoking.asp#pharmaco
Frequently a sked questions
How does the efficacy of NRT compare to other medications for smoking cessation?
NRT is equally effective as bupropion and nortriptyline in helping people to stop smoking. Varenicline has been shown to be
more effective than single dose NRT in achieving short-term cessation.
Are there any drug interactions with NRT?
No, there are no drug interactions with NRT. The metabolism of some drugs (e.g. clozapine, olanzapine) can decrease
following smoking cessation. This is not an effect of nicotine. For more information please refer to the New Zealand Smoking
Cessation Guidelines: http://www.moh.govt.nz/moh.nsf/indexmh/nz-smoking-cessation-guidelines
Is combination NRT more effective than single product NRT?
Yes, there is good evidence to show that combining two NRT products is more effective than single product use. Most smokers
should be recommended to use a patch with a faster acting NRT product (e.g. gum or lozenge).
Can NRT be used in pregnancy?
NRT use can be considered to help pregnant women who smoke to quit. NRT use in pregnancy is not without risk, however it is
generally accepted that any risk is outweighed by the risks of continuing to smoke tobacco. It is recommended that women use
short-acting NRT products (e.g. gum or lozenge) in the first instance. Where a patch is preferred the preferred treatment these
should be removed overnight. For more information refer to the New Zealand Smoking Cessation Guidelines.
Can people with cardiovascular disease use NRT?
Yes, NRT can be used by people with CVD.
References
1. Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database
of Systematic Reviews 2008(1):CD000146.
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