TOOL 5

Quick guide to Nicotine

Replacement Therapy (NRT)

NRT product Directions for use

Nicotine patch Apply to clean, non-hairy, dry skin on the upper body (chest, rib cage, back, side of
upper arm) and hold down for 10 seconds. Rotate to different parts of the body each
time a new patch is used to avoid skin rash. If client is given patch on admission they
may need a quick acting oral form of NRT as well to cover the time lag before the patch
kicks in.
Nicotine gum Should be chewed until a strong peppery taste and/or a tingling sensation is noticed.
Flatten and park the gum against the inside lining of the cheek or under the tongue for
1- 2 minutes or until the taste disappears (3-5 minutes). Chew again slowly until the taste
returns. Repeat for 30 minutes and then throw the gum away. Gum should not be
chewed like ordinary gum as it lowers its effectiveness.
Nicotine Roll the lozenge around in the mouth for a few times to start releasing nicotine. Park
lozenge between the cheek and the gum or under the tongue. Continue to move the lozenge
around the mouth every 5 minutes or so to continue to the release of nicotine. Repeat
the process for up to 30 minutes or until the lozenge is completely dissolved. Not
suitable for people with phenylketonuria.
Nicotine Puff gently - inhaling too deeply may cause coughing and sore throat. Puff on each new
inhalator cartridge for up to 20 minutes for maximum effect. Use the inhalator as often or as little
to assist with cravings up to a maximum of 40 minutes. After that time, throw away the
cartridge as the active ingredient is lost.Note: After 12 hours the used cartridge needs to
be thrown away (please dispose safely). The used cartridge will no longer be active even
if it has not been puffed on for a total of 40 minutes during that 12 hour period.
Mouth spray Shake the pump before using. ‘Prime’ the pump to ensure the spray comes out as a fine
mist not a squirt when using the spray for the first time. Hold the breath while directing
the spray to inside of the cheek or under the tongue. Refrain from swallowing for a few
seconds after spraying. Do not spray on the lips or directly onto the throat as it may
cause hiccups or a burning sensation on the lips or in the back of the throat.Seek advice
if you suffer from asthma or chronic throat conditions.Not recommended for recovering
alcoholics.

Contraindications
• Children under 12 years of age
• People with known hypersensitivity to nicotine or any other component of the NRT product.
• Note: People < 45 kg can use NRT but may require the lower dose such as a 14mg/24hr patch.

Precautions
• NRT should be used with caution for clients in hospital for acute cardiovascular events, but if the alternative
is smoking, NRT can be used under medical supervision.

Use in pregnancy and breastfeeding:

• NRT can be considered in pregnancy and breastfeeding if a woman is otherwise unable to quit smoking.
In pregnancy, oral NRT is preferred to patches. However if a woman cannot tolerate oral forms of NRT,
or requires combination therapy to control withdrawal symptoms, patches can be used but should be
removed at night.
• The NSW Health Quit for new life program is a smoking cessation support initiative for women having an
Aboriginal baby. A protocol for the provision of NRT to pregnant and postnatal women involved in the
program is available on the NSW Health website:
www.health.nsw.gov.au/tobacco/Pages/quit-for-new-life.aspx
NRT Dosage Chart
NRT product Strength Standard dosage range Optimum dosage
for single use therapy
2mg gum 8-12 per day • Client needs to be provided
Gum
4mg gum 6-10 per day with sufficient amount of
oral NRT to manage cravings
Inhalator 15mg cartridge 3-6 cartridges per day and withdrawal symptoms.
1 lozenge every 1-2 hours • Client should be encouraged
Mini lozenge 1.5 mg mini lozenge
Up to 20 per day to request additional oral
NRT if withdrawal symptoms
1 lozenge every 1-2 hours
Lozenge 2mg lozenge and/or cravings to smoke
Up to 15 per day
are not controlled.
1 lozenge every 1-2 hours • Remember, it is always
4mg lozenge
Up to 15 per day better to use more NRT to
1-2 sprays every 30 minutes control the urge to smoke
Oral spray 1mg than return to smoking.
or up to 4 sprays per hour

• This dosage chart is a guide only. Work closely with the client to determine an appropriate daily dosage of
NRT that controls cravings and withdrawal symptoms. Some clients will require more than one patch or a
combination of patch and oral NRT (See Tool 4 ‘Flowchart for NRT use in hospital’).
• Expired carbon monoxide (CO) monitoring is helpful to more accurately recommend an NRT strength and
dosage. Check to see if a Smokerlyzer is available for use in your area.
• Most clients will need the higher strength gum and lozenge (4mg) unless they are a very mildly nicotine
dependent (don’t smoke within 30 minutes of waking and experience only mild cravings).
• Client should be monitored closely while in hospital for withdrawal symptoms. (See NSW Health Monitoring
chart for nicotine withdrawal).
• For all forms of NRT, the recommended minimum usage = 12 weeks duration. Longer duration of use
increases the likelihood of success.
• At least 3 days’ supply of NRT used in hospital should be provided to clients on discharge. (See Tool 10
‘Discharge checklist for any client who was a smoker on or during admission’.)

Possible side effects of NRT products

No serious side effects of either short or long term NRT use have been reported over the 30 years it has been
in use. Side effects are relatively minor for most users however individuals may experience some minor effects
when using NRT. The most common ones and suggested ways to assist clients are listed below.

Form of NRT Possible side effect Ways to deal with the side effect
Nicotine Skin rashes where the patch is applied. Rotate the patch site and use
patches hydrocortisone 1% cream for skin irritation.
Patch keeps falling off – doesn’t stick Use stretch adhesive tape over patch
Sleep disturbance (can be due to caffeine Apply the patch in the morning rather than
© NSW Ministry of Health 2016SHPN (CPH) 160013

toxicity, timing of the patch or nicotine at night. Remove patch before sleep.
withdrawal). Decrease caffeine intake by half.
Neuralgia (uncommon) Change the patch location or reduce the
strength of the patch.
Oral NRT Irritation of the mouth or throat, headaches, Check for correct use of the oral product
products hiccups, indigestion, nausea, and coughing. or change to a different oral product.

Note: This is a guide only. Refer to Medical Officer if concerned about side effects.