Nicotine Patch Dosing for 1 Pack Per Week Smoker
For someone smoking 1 pack per week (approximately 3 cigarettes per day), start with a 14 mg (24-hour) or 15 mg (16-hour) nicotine patch combined with 2 mg nicotine gum as needed for cravings. 1
Rationale for Lower-Dose Patch Selection
Light smokers consuming fewer than 10 cigarettes per day should not use the standard 21 mg patch and instead should start with 14-15 mg patches to match their lower baseline nicotine intake. 1
At 1 pack per week (roughly 3 cigarettes daily), you fall well below the 10 cigarettes/day threshold that defines light smoking, making the lower-dose patch the appropriate starting point. 1
The 16-hour patch (15 mg) is designed for waking hours only and should be removed at bedtime, while the 24-hour patch (14 mg) is worn continuously—choose based on whether the patient experiences early morning cravings. 1
Combination Therapy is Essential
Pair the 14-15 mg patch with 2 mg nicotine gum (not 4 mg, which is reserved for heavy smokers) to achieve optimal quit rates. 1
Combination NRT (patch + fast-acting form) nearly doubles cessation success compared to patch alone, achieving 36.5% abstinence at 6 months versus 23.4% for monotherapy (RR 1.25,95% CI 1.15-1.36). 1, 2
Instruct the patient to use 8-12 pieces of 2 mg gum per day as needed for breakthrough cravings. 1
Proper Gum Technique is Critical
The patient must use the "chew and park" method: chew slowly until a peppery taste emerges, then park the gum between cheek and gum for nicotine absorption through the oral mucosa. 2, 3
Swallowed nicotine is metabolized by the liver before reaching systemic circulation and provides no therapeutic benefit—this is a common reason for NRT failure. 2
The unpleasant taste typically resolves within one week as patients adapt. 3
Treatment Duration and Follow-Up
Continue combination NRT for a minimum of 12 weeks, with consideration for extending therapy to 6 months or longer if needed to maintain cessation. 1, 3
Schedule follow-up within 2 weeks of starting therapy, then at minimum 12-week intervals to monitor withdrawal symptoms and adherence. 1, 3
Longer duration therapy (>14 weeks) shows superior results to standard 8-12 week courses. 1
Dose Adjustment Strategy
If withdrawal symptoms persist despite the 14-15 mg patch plus gum combination, consider increasing to a 21 mg patch rather than abandoning NRT. 1
Monitor for signs of under-dosing (persistent cravings, irritability, difficulty concentrating) versus over-dosing (nausea, dizziness, palpitations). 1
Safety Considerations
Combination NRT is safe, with blood nicotine levels remaining significantly lower than from smoking cigarettes, making toxicity rare. 1
Very few people become addicted to NRT itself—the risk is substantially lower than continued smoking. 1, 3
Common side effects include local skin reactions from patches and mouth irritation from gum, both typically mild and manageable. 1, 3
Critical Success Factors
Combining pharmacotherapy with behavioral counseling increases quit rates from 8.6% to 15.2% compared to brief advice alone. 1
Ensure adequate dosing to control withdrawal symptoms—inadequate dosing is a common pitfall leading to relapse. 1
Encourage continued therapy even through brief slips, as premature discontinuation undermines long-term success. 1