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Tobacco Treatment Medication Dosing Chart
be needed for
risk of side
Signs of excessive nicotine include: rapid heart rate, chest pain, dizziness, stomachache, diarrhea, nausea, vomiting,
rare, or serious
drooling, cold sweat, weakness, headache, confusion, shaking, seizure
but not limited
Unstable cardiovascular disease and some acute post-op conditions – consult with physician.
Monitor or consider alternatives if: peptic ulcer disease, endocrine disorders, severe kidney or liver disease, malignant
Must consider risks/benefits/alternatives to medication. Pregnant/lactating women
: limited safety testing, no meds FDA approved for tobacco treatment. Youth
: no evidence for
efficacy; probably safe; no FDA approved medication. Cardiovascular disease
: NRT considered safe for most, but caution if recent MI or stroke, arrhythmia, unstable angina; 2011
CVD warnings with varenicline; bupropion may increase BP; consult with physician. Psychiatric disorders
: all are generally safe, but potential for psychiatric destabilization with
nicotine withdrawal, changes in psych med metabolism, and/or some of these medications, consider psychiatric consultation.
Possible for any of these medications. Symptoms include: difficulty breathing or swallowing; swelling of face, mouth, tongue, lips; hives; blistering rash. Immediate medical assistance
recommended. Past hypersensitivity or allergic reactions to the medication or any of its components is a contraindication for use.
Treatment is recommended for 3 months for most medications, but longer is appropriate for many people. Consultation with a health care provider is recommended for longer duration.
Medication Dosing Guidelines for the Treatment of Smokeless Tobacco and Cigars
If using 1 can/week, suggest starting dose of 21-mg patch/day OR 4 mg gum OR 4 mg lozenge.
If using < 1 can/week, suggest starting dose of 14-mg patch/day OR 2 mg gum OR 2 mg lozenge. Consider bupropion at same dose for cigarette use.
If using small cigars, consider dosing similar to that of smoking cigarettes.
If using 2 or more medium size cigars/day suggest starting with 21 mg patch OR 4 mg gum OR 4 mg lozenge. If using 1 or more large, stogie-sized cigars/day, suggest starting with 21 mg patch OR 4 mg gum OR 4 mg lozenges. Consider bupropion at same dose for cigarette use.
The PHS Clinical Practice Guideline 2008 update does not recommend use of tobacco treatment medications for smokeless tobacco use due to lack of sufficient evidence of its efficacy. The variety of products and individual differences in use patterns make it difficult to have precise dose guidelines. We recommend that tobacco treatment specialists discuss this with their clients and help clients monitor and adjust dose and frequency of NRT based on symptoms, increasing dose if withdrawal symptoms are high and decreasing if there are symptoms of nicotine excess.
This chart is strictly for the convenience of consumers and providers. Information is simplified and may not reflect most recent safety updates. Consumers are advised to consult a physician, nurse or tobacco treatment specialist for more information regarding individual circumstances. Providers are advised to consult MedlinePlus® or manufacturer for more product information. Prices are approximations based on those found at 1. By comparison, the average price of cigarettes in Maine as of 02/09 is $6-$7/pack.
STORE ALL MEDICATIONS OUT OF THE REACH OF PETS AND CHILDREN Dispose of used medications properly. Updated 10/11
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