What is the recommended dosage of nicotine (nicotine replacement therapy) gum?

From the Guidelines

Nicotine gum should be used at a starting dose of 4 mg if the first tobacco use is within 30 minutes of waking, and 2 mg if the first tobacco use is more than 30 minutes after waking. The dosing of nicotine gum is crucial in managing withdrawal symptoms and quitting smoking. According to the 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease 1, the recommended starting dose for nicotine gum is 4 mg if the first tobacco use is within 30 minutes of waking, and 2 mg if the first tobacco use is more than 30 minutes after waking.

Key Points to Consider

• The gum comes in two strengths: 2mg and 4mg
• Use one piece every 1-2 hours for the first six weeks
• Chew until you notice a peppery taste or tingling sensation, then "park" it between your cheek and gums until the sensation fades
• Repeat this chew-and-park method for about 30 minutes per piece
• Gradually reduce usage over the following six weeks, then taper off during the final six weeks
• Most people should not use more than 24 pieces per day

Important Considerations

• Avoid eating or drinking (except water) for 15 minutes before and during use, as acidic beverages like coffee or juice can reduce nicotine absorption
• The gum works by delivering controlled amounts of nicotine to reduce withdrawal symptoms while you break the smoking habit
• It is essential to follow the recommended dosing and usage guidelines to maximize the effectiveness of nicotine gum in quitting smoking, as supported by the 2019 ACC/AHA guideline 1

From the FDA Drug Label

Directions - 2 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 within 30 minutes of waking up, use 4 mg nicotine gum if you smoke your first cigarette more than 30 minutes after waking up, use 2 mg nicotine gum according to the following 12 week schedule: Weeks 1 to 6 Weeks 7 to 9 Weeks 10 to 12 1 piece every 1 to 2 hours 1 piece every 2 to 4 hours 1 piece every 4 to 8 hours nicotine gum is a medicine and must be used a certain way to get the best results chew the gum slowly until it tingles. Then park it between your cheek and gum When the tingle is gone, begin chewing again, until the tingle returns repeat this process until most of the tingle is gone (about 30 minutes) 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 nicotine gum dosage is as follows:

• If you smoke your first cigarette within 30 minutes of waking up, use 4 mg nicotine gum.
• If you smoke your first cigarette more than 30 minutes after waking up, use 2 mg nicotine gum.
• The gum should be used according to the following 12-week schedule:
  • Weeks 1 to 6: 1 piece every 1 to 2 hours
  • Weeks 7 to 9: 1 piece every 2 to 4 hours
  • Weeks 10 to 12: 1 piece every 4 to 8 hours
• Use at least 9 pieces per day for the first 6 weeks.
• Do not use more than 24 pieces a day 2

From the Research

Nicotine Gum Dosage

• The optimal dosage of nicotine gum for smoking cessation is not explicitly stated in the provided studies, but the studies mention the use of 2 mg 3 and 4 mg 4 nicotine gum.
• A study using 2 mg nicotine gum found that it did not significantly improve outcomes for non-daily smokers 3.
• Another study using 4 mg nicotine gum found that it resulted in a significantly higher abstinence rate than placebo 4.
• The frequency of gum use varied across studies, with one study reporting an average of 1 gum per day 3 and another reporting an average of 6 pieces per day 5.

Effectiveness of Nicotine Gum

• Nicotine gum has been shown to be effective in increasing smoking cessation rates, with a study from 2007 reporting a 1.5- to 2-fold increase in cessation rates after 12 months 6.
• However, a 2020 study found that 2 mg nicotine gum did not improve cessation rates among non-daily smokers 3.
• A 2013 study found that nicotine gum was less effective than varenicline and bupropion in terms of satisfaction, perceived relief of craving/withdrawal, and effectiveness 5.

Comparison with Other Treatments

• Nicotine gum has been compared to other treatments such as bupropion and varenicline, with some studies finding that these treatments may be more effective 6, 7.
• A 2013 study found that bupropion was more effective than nicotine replacement therapy, including gum, for smokers with a history of depression 7.
• A 2009 study found that nicotine gum and inhaler were effective in helping smokers quit or reduce their smoking, with significantly higher abstinence rates than placebo 4.