In this week’s pearl we will rew FDA-Approved nicotine replacement therapies and their dosing
Suggested regimens are based on the CHEST Foundations Tobacco Dependence Treatment Toolkit
Consider extended durations (i.e.>12 weeks) in individuals who have a high level of nicotine dependence and or serious Tobacco-related health comorbidities.
Note that the patch, gum, and lozenge are available over the counter and can be used in combination.
Transdermal Nicotine Pouch
<= 10 cigarettes/day: Start with 14mg/day for 6 weeks or longer if needed
> 10 cigarettes/day: Start with 21 mg/day for 6 weeks or longer if needed
Nicotine Polacrilex Gum
1st cigarette >30 min after awakening: 2mg/hr
1st cigarette <30 min after awakening: 4 mg/hr
If patient experiences throat pain, consider reducing the dose
Nicotine lozenge
1st cigarette<30 min after awakening: 2 mg/hr
1st cigarette>30 min after awakening: 4 mg/hr
If patient experiences throat pain consider decreasing dose
Nicotine Nasal Spray
1-2 sprays per nostril/hr PRN
May increase to 5 sprays per nostril/hr. (Max 80 sprays total) for 3 months maximum
This prescription cannot exceed 3 months.
As a result patient should be tapered off or switched to an alternative NRT within 3 months
Nicotine Inhaler
4 puffs/min x 20-30 mins per cartridge = 1.5-2 cigarettes prn.
References
American Society of Addiction Medicine. Integrating Tobacco Use Disorder Interventions in Addiction Treatment: A Guide for Addiction Treatment Clinicians and Programs. American Society of Addiction Medicine. Accessed July 12, 2026. https://downloads.asam.org/sitefinity-production-blobs/docs/default-source/guidelines/tobacco-guide.pdf?sfvrsn=c8d48d75_8