Recommended Regimen for Nicotine Patch and Nicotine Gum in Smoking Cessation
The most effective regimen for smoking cessation combines a nicotine patch with nicotine gum, using the patch continuously and the gum as needed for breakthrough cravings for at least 12 weeks. 1
Nicotine Patch Regimen
For smokers of more than 10 cigarettes per day:
- Weeks 1-4: 21 mg patch daily
- Weeks 5-6: 14 mg patch daily
- Weeks 7-8: 7 mg patch daily 2
For smokers of 10 or fewer cigarettes per day:
- Weeks 1-6: 14 mg patch daily
- Weeks 7-8: 7 mg patch daily 2
Nicotine Gum Regimen
Dosage selection:
- 4 mg gum: For smokers who have their first cigarette within 30 minutes of waking
- 2 mg gum: For smokers who have their first cigarette more than 30 minutes after waking 3
Usage schedule:
- Weeks 1-6: 1 piece every 1-2 hours (at least 9 pieces per day)
- Weeks 7-9: 1 piece every 2-4 hours
- Weeks 10-12: 1 piece every 4-8 hours 3
Proper Gum Technique
- Chew slowly until you feel a tingling sensation
- Park the gum between your cheek and gum when you feel the tingle
- When the tingle fades, begin chewing again
- Repeat for about 30 minutes per piece
- Do not eat or drink for 15 minutes before or during gum use 3
Evidence for Combination Therapy
Combination NRT (nicotine patch plus a short-acting form like gum) is more effective than using a single form of NRT. The patch provides steady background nicotine levels to prevent withdrawal symptoms, while the gum offers immediate relief for breakthrough cravings 1.
Research shows that smokers using combination NRT are almost 3 times more likely to quit successfully compared to placebo (OR, 2.73; 95% CI, 2.07-3.65), and have 34% higher odds of quitting compared to single NRT forms (OR, 1.34; 95% CI, 1.18-1.51) 1.
Duration of Treatment
- A minimum of 12 weeks of combination NRT is recommended for the initial quit attempt 1
- Treatment may be extended to 6 months or even 1 year for those who need continued support 1
- Longer-term patch use (>14 weeks) has been shown to be more effective than standard duration 1, 4
Behavioral Support
While NRT can be effective on its own, adding behavioral support significantly increases success rates:
- Combining behavioral and pharmacotherapy interventions may increase cessation rates from approximately 8% to 14% 1
- A minimum of 4 sessions of individual/group therapy in 12 weeks is preferred 1
- Follow-up is recommended within 2-3 weeks after starting pharmacotherapy and at 12-week intervals 1
Common Pitfalls and How to Avoid Them
Inadequate dosing: Many smokers don't use enough NRT. Ensure at least 9 pieces of gum are used daily during the first 6 weeks 3.
Improper gum technique: Chewing nicotine gum like regular gum reduces effectiveness and causes side effects. Follow the "chew and park" method 3.
Premature discontinuation: Stopping NRT too early is a common cause of relapse. Complete the full treatment course 2, 3.
Concerns about safety: Blood nicotine levels from NRT, including combination therapy, are significantly lower than from smoking cigarettes. NRT is well-tolerated and nicotine toxicity is rare 1.
Inadequate treatment of breakthrough cravings: If experiencing strong cravings despite using the patch, a second piece of gum may be used within the hour (but do not continuously use one piece after another) 3.
Fear of dependence: The risk of becoming dependent on NRT is low compared to cigarettes 4.
Management of Relapse
If relapse occurs with combination NRT:
- Continue or resume the combination NRT
- Intensify behavioral therapy
- Consider adjusting the dose if side effects or inadequate control of cravings are issues 1
Remember that nicotine withdrawal symptoms typically peak within 1-2 weeks of quitting. Encourage continued therapy even through brief slips, as patients who don't quit immediately may succeed after withdrawal symptoms subside 1.