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Nicotine replacement therapy (NRT)

Nicotine

Brand names: NicoRette, Niquitin, Nicabate, Nicotinell

Nicotine replacement therapy (NRT) supplies nicotine without the harmful tar and combustion products of tobacco, supporting smoking cessation and harm reduction. It is available as patches, gum, lozenges, an inhalator, a nasal or mouth spray, and other oral forms.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Directions 2 mg : if you are under 18 years of age, ask a doctor before use. No studies have been done to show if this product will work for you. before using this product, read the enclosed User’s Guide for complete directions and other important information begin using the lozenge on your quit day if you smoke your first cigarette within 30 minutes of waking up, use 4 mg nicotine lozenge if you smoke your first cigarette more than 30 minutes after waking up, use 2 mg nicotine lozenge according to the following 12 week schedule: Weeks 1 to 6 Weeks 7 to 9 Weeks 10 to 12 1 lozenge every 1 to 2 hours 1 lozenge every 2 to 4 hours 1 lozenge every 4 to 8 hours nicotine lozenge is a medicine and …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-07-04. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It provides a controlled dose of nicotine that stimulates nicotinic acetylcholine receptors, easing withdrawal symptoms and cravings while the person breaks the behavioural habit of smoking.

Prescribing in practice

  • NRT is far safer than continued smoking and can be used in cardiovascular disease and in pregnancy where it supports quitting.
  • Combining a long-acting patch with a faster-acting form (such as gum, lozenge, inhalator or spray) controls breakthrough cravings better than a single product.
  • Local irritation, nausea, palpitations, headache and sleep disturbance with vivid dreams can occur; removing the patch at night helps if dreams are troublesome.

Monitoring

Routine biochemical monitoring is not required; review the person's progress, craving control, side effects and whether the product type or combination needs adjusting.

Counselling the patient

  • Stop smoking completely while using NRT, and use a fast-acting form whenever cravings break through.
  • If you get vivid dreams or poor sleep, take the patch off at night and reapply in the morning.
  • Mild skin irritation, hiccups or a sore mouth/throat can occur; rotate patch sites and report anything troublesome.

Evidence & guidelines

Recommended for smoking cessation by NICE (NG209).

Reference: NICE NG209; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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