Consider nicotine replacement therapy preparations shown to be effective in smoking cessation including transdermal patch, nicotine gum, nicotine nasal spray, and nicotine inhalers. Choose nicotine replacement therapy according to individual preferences, tolerability of the product, and financial cost.

• Use 16- to 24-hour patches containing up to 22 mg of nicotine per 24-hour period and administer for 8 to 16 weeks, either tapering off or abruptly discontinuing.
• Use nicotine gum in a fixed dose regimen or as needed. Use the 4-mg dose of gum for highly dependent smokers, and 2 mg to 4 mg for others.

Evidence:

• A Cochrane review of nicotine replacement therapy for smoking cessation found no difference in effectiveness of the various forms of nicotine replacement therapy, with indirect comparisons made across trial of different therapies. There was also no significant difference between 16-hour and 24-hour patches, 8 weeks of therapy or longer, or between abrupt withdrawal of nicotine replacement therapy vs. gradual taper. There was no clear evidence for high-dose nicotine replacement therapy (>22 mg/24 hours), but it may be of use for selective smokers. The 4-mg gum was more effective than the 2-mg gum (OR, 2.67 [CI, 1.69 to 4.22]) for highly dependent smokers but not for low dependency smokers (42)
• A trial of 504 patients randomized smokers to one of four forms of nicotine replacement therapy: gum, spray, patch, or inhaler. Abstinence rates were similar in each group at 12 weeks (76).

Comments:

• None.