PATIENT GROUP DIRECTION (PGD): Nicotine Replacement Therapy
APPENDIX A: Typical dosages and method of administration of specific NRT products
Products should be supplied as original packs whenever possible. These should be of an appropriate quantity that is sufficient for the length of
supply required. Please note we are only supplying up to a maximum 7 weeks treatment. A secondary product may be supplied for up to 3
weeks with the programme if required.
PATCHES
Dose and
method of
administration
Transdermal administration. Apply on waking to dry, non-hairy skin on hip, chest or upper arm. Remove after time specified.
New patch should be placed on a different area – avoiding ‘used’ sites for several days afterwards. Patches should not be
applied to broken or inflamed skin.
If successful then gradually reduce dosage with time but review treatment if individual has not stopped smoking at 12 weeks
Nicotine – 16 hour patch
In accordance with manufacturers instructions.
In line with clients assessed requirements and in accordance with formulary (see Appendix III)
Nicotine – 24 hour patch
In accordance with manufacturers instructions.
In line with clients assessed requirements and in accordance with formulary (see Appendix III)
Side effects
Skin reactions. Discontinue use if severe
Additional
advice to client
Exercise may increase absorption of nicotine and therefore side effects.
Place the patch in the palm of the hand and hold onto the skin for 10-20 seconds.
Once the patch is spent it should be folded in half and disposed of carefully.
Clients should not try to alter the dose of the patch by cutting it up.
Appendix Av.5 (Feb 2015)
PATIENT GROUP DIRECTION (PGD): Nicotine Replacement Therapy
GUM
Dose and
method of
administration
Oral administration (as resin).
Nicotine 2mg gum
In accordance with manufacturers instructions.
In line with clients assessed requirements and in accordance with formulary (see Appendix III)
Nicotine 4mg gum
In accordance with manufacturers instructions.
In line with clients assessed requirements and in accordance with formulary (see Appendix III)
Side effects
Additional
advice to client
Liquorice gums are contraindicated in pregnancy + lactation. Mint and fruit gum may be considered.
Aphthous ulceration (sometimes with swelling of tongue), throat irritation, increased salivation, hiccups.
Gum should be chewed until the taste becomes strong and then ‘parked’ between the gum and cheek until the taste fades.
Recommence chewing once the taste has faded. This ‘chew-rest-chew’ technique should be applied for 30 minutes.
Withdraw gradually after 3 months
INHALATOR
Dose and
method of
administration
Impregnated plug for use in inhalator mouthpiece
Side effects
Additional
advice to client
Nicotine 15mg cartridge: The frequency of use should depend on the previous smoking habit of the individual. Nicorette
Inhaler should be used whenever the urge to smoke is felt, up to a maximum usage of 6 cartridges per day. Each cartridge
can be used for approximately eight 5-minute sessions, with each cartridge lasting approximately 40 minutes of intense use.
For up to 8 weeks the patient uses not less than 3 and not more that 6 cartridges each day to relieve craving. Over the
following two weeks the aim is to reduce the number of cartridges used by half, over the next two weeks to reduce the
number to zero by the last day.
In accordance with manufacturers instructions.
In line with clients assessed requirements and in accordance with formulary (see Appendix III)
Aphthous ulceration (sometimes with swelling of tongue), throat irritation, cough, rhinitis,
Nicotine is obtained by inhaling deeply or shallow puffing. The effort required is greater then inhaling on a cigarette. .
Mouthpiece must be cleaned several times per week by rinsing in water and drying.
Appendix Av.5 (Feb 2015)
PATIENT GROUP DIRECTION (PGD): Nicotine Replacement Therapy
LOZENGE
Dose and
method of
administration
Side effects
Additional
advice to client
Sublingual administration (as polacrilex).
Nicotine – 1mg, 1.5mg and 2mg
In accordance with manufacturers instructions.
In line with clients assessed requirements and in accordance with formulary (see Appendix III)
Nicotine – 4mg lozenge
In accordance with manufacturers instructions.
In line with clients assessed requirements and in accordance with formulary (see Appendix III)
Lozenges are contraindicated in clients who have phenylketonuria and those who require a low Sodium diet (Lozenges
contain 15mg sodium)
Aphthous ulceration (sometimes with swelling of tongue), throat irritation, unpleasant taste and increased salivation.
Allow lozenge to slowly dissolve in mouth, periodically moving it from one side of mouth to the other. Should NOT be chewed
or swallowed whole.
Maximum treatment period 24 weeks
MOUTH SPRAY (not for supply under CDTQ PGD)
Nicotine mouth spray – delivers 1mg per spray. Each mouth spray contains at least 150 sprays.
Dose and
method of
To administer a dose, point the spray nozzle as close to the open mouth as possible. Press the top of the dispenser and
administration
release one spray into the mouth, avoiding the lips. Advise client not to inhale and not to swallow for a few seconds after
spraying.
Use 1 or 2 sprays when cigarettes would normally been smoked. If cravings not controlled after one spray, a second spray
may be used. Most smokers will require 1-2 sprays every 30 minutes to 1 hour, up to 4 sprays per hour. Use no more than 2
sprays at any one time and no more than 64 sprays in 24 hours.
* ONLY TO BE SUPPLIED AS SECONDARY PRODUCT*
Side effects
Irritation to mouth and throat. Increased incidence of aphthous ulceration may occur.
Additional
advice to client
For the first few days of the course, there may be irritation to the mouth or throat but this should decline with continued use.
Appendix Av.5 (Feb 2015)
PATIENT GROUP DIRECTION (PGD): Nicotine Replacement Therapy
Nicotine Strips
Dose and
method of
administration
NiQuitin Strips Mint 2.5 mg Oral Film: Each orodispersible film contains 2.5 mg nicotine
To administer, place one strip on the tongue. Close the mouth and press the tongue gently to the roof of the mouth until the
nicotine strip dissolves (approximately 3 minutes). The strip should not be chewed or swallowed whole. Users should not eat
or drink while a nicotine strip is in the mouth
It is recommended that users take a minimum of 9 strips per day but not exceed 15 strips per day
Side effects
Aphthous ulceration (sometimes with swelling of tongue), throat irritation, increased salivation, hiccups
Additional
advice to client
For the first few days of the course, there may be irritation to the mouth or throat but this should decline with continued use
Appendix Av.5 (Feb 2015)