How much nicotine should I be taking?

Posted by DrMendelsohn on 1 January, 2014


Answer. Enough to relieve withdrawal symptoms and cravings when you quit

 

Most people using nicotine replacement therapy (NRT), such as nicotine patches, lozenges, mouth spray, gum and inhalator, do not get enough nicotine and this is the main reason why the treatment fails. The right dose for you is the amount you need to relieve your withdrawal symptoms, such as feeling anxious, restless, having difficulty concentrating and cravings to smoke.

Every smoker is different. Some people metabolise nicotine (break it down) more quickly and need bigger doses to have an effect. Heavier smokers and those with more intense withdrawal symptoms also need more nicotine. Some smokers have a short latency period (they need cigarettes more frequently) and will also need more frequent doses of nicotine replacement as well.

Bigger doses also increase quit rates. For example, research shows that for every additional daily nicotine lozenge used, the quit rate rises by a further 10%. (1)

Are larger doses safe?

You should not worry about overdosing on NRT. When using NRT, the average amount of nicotine being delivered is about one third to one half of the amount you get from smoking. Even when you increase the dose, most people still usually get less than from smoking.

The worst that will happen from getting too much nicotine is nausea or dizziness. If this occurs, you simply need to cut back a little. There are no reported cases of a smoker dying from an overdose of nicotine. However, smoking kills nearly 6 million people in the world every year. Using NRT is always safer than smoking. (2)

Nicotine is not the main toxic ingredient in tobacco smoke and only causes relatively minor health effects. Nicotine does not cause heart disease, cancer or lung disease. It is the other 6,000 chemicals in smoke that harm the body. (2)

How to work out the right dose

If you smoke 10 or more cigarettes per day, start with a single, full-strength nicotine patch in the morning (eg Nicabate 21mg, Nicotinell 21mg, Nicorette 25mg) to relieve background cravings. Most people also need to use a quick-acting form of nicotine as well, such as nicotine lozenges or mouth spray, for breakthrough cravings as needed through the day. (3)

If you still have withdrawal symptoms or have the urge to smoke, add a second patch or third patch or increase the number of doses of quick-acting nicotine. You may need to take the quick-acting doses on a regular basis, such as every 30 or 60 minutes to keep cravings at bay.

The number of doses in the packaging is just a guide. It is safe to take more until your symptoms are relieved. (3)

 

References

1) Shiffman S. Use of more nicotine lozenges leads to better success in quitting smoking. Addiction 2007

2) Zwar N et al. Nicotine and NRT - the facts. Pharmacist 2006

3) Mendelsohn C. Optimising nicotine replacement therapy in clinical practice. Australian Family Physician 2013

 

What has been your experience with nicotine dosing? Please share them below.

 

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