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Nicotine Content in Tobacco Products
Nicotine content
Suggested Rx
Cigarettes
1.1mg to 1.8mg per cigarette
21mg patch QD x28 days plus NRT gum or
(22mg to 36mg/pack)
NRT lozenge (4mg/2mg). Evaluate decrease
patch dose monthly (PACT nurses to track?).
May add Bupropion if no contraindications.
13.3mg average
Patch and Short Acting NRT (4mg/2mg) based
on # of cigars per day. May add Bupropion if
no contraindications.
Mini-cigars (i.e. ‘Swishers or Dark Horse)
3.8mg per mini-cigar = 76mg/pack
42mg to 21mg (depending on # smoked) plus
Short Acting NRT (4mg/2mg). May add
Bupropion if no contraindications.
5.2mg average per bowl
Patch and Short Acting NRT (4mg/2mg) based
on # of bowls smoked per day. May add
Bupropion if no contraindications.
Chewing/dipping can (i.e. Skoal,
88mg per can of dip/chew
42mg Patch and Short Acting NRT
Copenhagen)
(4mg/2mg). May add Bupropion if no
contraindications.
Loose leaf pouch (i.e. Redman)
144mg per pouch
42mg Patch and Short Acting NRT
(4mg/2mg). May add Bupropion if no
contraindications.
Hookah (water pipe)
One 45-60 minute session = approximately
21mg Patch and Short Acting NRT
one pack of cigarettes in nicotine and tar
(4mg/2mg). May add Bupropion if no
contraindications.
Bidi’s (hand rol ed cigarettes imported from
One bidi contains 3 to 5 times as much
Patch and Short Acting NRT (4mg/2mg) based
nicotine as a regular cigarette
on # of bidi’s smoked per day. May add
Bupropion if no contraindications.
Kretek (Clove cigarette)
Little research available. Increased risk of
Short Acting NRT (4mg/2mg) based on # of
acute lung injury, especial y with asthma or
Kretek’s per day. May add Bupropion if no
respiratory infections.
contraindications.
References available on request
Clinical Pearls
Optimal length of treatment is not established for NRT
Evidence for using NRT gum/lozenge for 6 months or greater, results in improved quit rates
Combination of NRT patches and NRT gum/lozenge or NRT patches and gum/lozenge + Bupropion is most effective
NRT gum/lozenge absorption is affected by pH: advise against drinking coffee, tea, soda, juice while gum/lozenge is in mouth
Advise using NRT gum/lozenge to ‘stay ahead of the craving’ by using a piece every hour while awake (or at least for the first 3 hours),
especially within the first 7-30 days
Use of Bupropion for 52 weeks produces about 42% successful quit
Bupropion can be used with Prozac, Zoloft, Celexa and most al meds for depression
Bupropion contraindicated if: known seizure disorder (ever); structural brain abnormality; serious closed head injury (unconscious for
30 minutes or greater within past 5 years)
Initial symptom of nicotine toxicity = NAUSEA
Electronic cigarettes: not regulated; can contain from 0mg to .2mg to 2mg per e-cigarette; many brands contain nitrosamines (cancer
causing agents) despite label saying otherwise; active ingredient of antifreeze added to most brands to produce ‘puff of smoke’
Two problems: 1.) physical addiction to nicotine (out in 72 hours) and, 2.) psychological/behavioral problem. Treating only physical
addiction = high failure rate.
Strongly advocate use of
VA groups and/or individual therapy
Quit lines (1-800-QUITNOW or American Lung Association 1-800-784-8937)
Internet resources oror)
Family/friend support

Source: http://eo2.commpartners.com/users/apna_kc/downloads/3031-Essenmacher_-_Handout_1.pdf

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