What is the recommended dosing for nicotine (nicotine replacement therapy) gum for smoking cessation?

From the Guidelines

Nicotine gum is recommended at a dose of 4 mg if the first tobacco use is within 30 minutes after waking, and 2 mg if the first tobacco use is more than 30 minutes after waking. This dosing strategy is based on the 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease 1. The guideline suggests that the starting dose of nicotine gum should be determined by the time of first tobacco use after waking.

• Key points to consider when using nicotine gum for smoking cessation include:
  • Chew and park the gum to allow for proper nicotine absorption
  • Use a maximum of 24 pieces of gum per day
  • Treatment typically lasts 12 weeks, with gradual reduction in use during the final weeks
  • Avoid eating or drinking (except water) for 15 minutes before and during use to maximize nicotine absorption, as acidic beverages can reduce nicotine absorption 1.
• It is essential to follow the recommended dosing and usage guidelines to ensure the effectiveness of nicotine gum in smoking cessation and to minimize potential side effects.

From the FDA Drug Label

Directions - 4 mg if you are under 18 years of age, ask a doctor before use before using this product, read the enclosed User's Guide for complete directions and other important information begin using the gum on your quit day if you smoke your first cigarette more than 30 minutes after waking up, use 2 mg nicotine gum if you smoke your first cigarette within 30 minutes of waking up, use 4 mg nicotine gum according to the following 12 week schedule: Weeks 1 to 6 Weeks 7 to 9 Weeks 10 to 12 1 piece every1 to 2 hours 1 piece every2 to 4 hours 1 piece every4 to 8 hours do not eat or drink for 15 minutes before chewing the nicotine gum, or while chewing a piece to improve your chances of quitting, use at least 9 pieces per day for the first 6 weeks if you experience strong or frequent cravings, you may use a second piece within the hour However, do not continuously use one piece after another since this may cause you hiccups, heartburn, nausea or other side effects. do not use more than 24 pieces a day

The recommended dosing for nicotine gum for smoking cessation is:

• 2 mg if the first cigarette is smoked more than 30 minutes after waking up
• 4 mg if the first cigarette is smoked within 30 minutes of waking up According to the following 12-week schedule:
• Weeks 1-6: 1 piece every 1-2 hours
• Weeks 7-9: 1 piece every 2-4 hours
• Weeks 10-12: 1 piece every 4-8 hours It is recommended to use at least 9 pieces per day for the first 6 weeks and not more than 24 pieces a day 2

From the Research

Nicotine Gum Dosing for Smoking Cessation

• The recommended dosing for nicotine gum for smoking cessation is not explicitly stated in the provided studies, but the effectiveness of different doses is compared in several studies 3, 4, 5.
• A study found that 4 mg gum is more effective than 2 mg gum, especially for highly dependent smokers (RR 1.43, 95% CI 1.12 to 1.83) 3, 4, 5.
• However, the optimal dose of nicotine gum is not clearly established, and the effectiveness of different doses may vary depending on individual factors such as smoking history and level of nicotine dependence.
• Combination NRT, which includes nicotine gum, has been shown to be more effective than single-form NRT (RR 1.25, 95% CI 1.15 to 1.36) 4, 5.

Comparison of Nicotine Gum to Other NRT Forms

• Nicotine gum has been compared to other forms of NRT, such as patches, lozenges, and inhalers, in several studies 3, 4, 5.
• The studies found that nicotine gum is as effective as other forms of NRT, including patches (RR 0.90, 95% CI 0.77 to 1.05) 4, 5.
• However, the choice of NRT form may depend on individual preferences and needs, and nicotine gum may be more suitable for some smokers than others.

Safety and Tolerability of Nicotine Gum

• The safety and tolerability of nicotine gum have been evaluated in several studies 3, 4, 5.
• The studies found that nicotine gum is generally well-tolerated, but may cause adverse effects such as mouth irritation and jaw pain 3, 4, 5.
• However, the evidence for the comparative safety and tolerability of different types of NRT use is limited, and more research is needed to fully understand the risks and benefits of nicotine gum and other NRT forms 4, 5.