Can I prescribe Nicorette (nicotine) gum for smoking cessation?

Prescribing Nicorette Gum for Smoking Cessation

Yes, you can prescribe Nicorette gum as an effective nicotine replacement therapy (NRT) for smoking cessation. 1 Clinical trials have shown that NRT doubles the chance of success for smokers wishing to quit, making it a valuable tool in helping patients overcome tobacco dependence.

Effectiveness and Patient Selection

Nicorette gum is appropriate for most smokers attempting to quit, with specific considerations:

• Most effective for smokers who are motivated to quit
• Available in 2 mg and 4 mg strengths:
  • 2 mg gum: For smokers who have their first cigarette MORE THAN 30 minutes after waking 2
  • 4 mg gum: For heavy smokers or those who smoke their first cigarette WITHIN 30 minutes of waking 1, 2
  • Higher dose (4 mg) shows greater benefit in highly dependent smokers (RR 1.43,95% CI 1.12 to 1.83) 3

Administration Guidelines

• Instruct patients on proper use:
  • Chew slowly to maximize nicotine absorption through the mouth
  • Any swallowed nicotine is wasted and may cause stomach upset
  • Most patients adapt to the taste within a week 1
• Dosing:
  • Recommend using at least 9 pieces per day during the first six weeks 2
  • Continue for the full 12-week recommended treatment course 2
  • Patients should follow package instructions and can seek pharmacist advice if needed

Contraindications and Cautions

• Pregnancy: Currently contraindicated in the UK, though NRT is likely safer than continued smoking 1
• Cardiovascular disease: Package inserts advise consulting with healthcare provider first, though NRT is not an independent risk factor for acute myocardial events 1
• Age restrictions: Some products are not recommended for people under 18, though this restriction may not apply to all gum formulations 1

Combination Therapy Considerations

• Combination NRT (patch plus fast-acting form like gum) has higher success rates than single forms alone (RR 1.25,95% CI 1.15 to 1.36) 3
• Consider combination therapy for patients with significant withdrawal symptoms or those who have failed monotherapy

Patient Education Points

When prescribing, emphasize these key points:

• NRT is not a "magic cure" - it reduces but doesn't eliminate cravings and withdrawal symptoms
• Willpower and behavioral support are still important components of quitting
• NRT provides nicotine in a safer, less addictive form without the tar and carbon monoxide of cigarettes
• Very few people become addicted to NRT 1
• For best results, adequate dosing and duration are essential

Follow-up and Support

Provide the prescription with additional support:

• Recommend behavioral support alongside NRT to maximize success
• The effectiveness of NRT appears largely independent of the intensity of additional support, but support is still beneficial 1, 4
• Schedule follow-up to assess progress and address any side effects or compliance issues

Nicorette gum is a safe, effective, and accessible option for smoking cessation that can significantly improve your patients' chances of successfully quitting smoking and reducing their risk of smoking-related morbidity and mortality.