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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