Review of nicotine replacement therapy

Review tolerability and effectiveness of nicotine replacement therapy (NRT) 2 weeks after starting and at intervals during a minimum 12-week course.

NRT is generally well tolerated. Excess use may cause mild symptoms of nicotine toxicity, most commonly dizziness, nausea and palpitations. If the patient is still smoking, explain how this is contributing to their symptoms and encourage them to cut down or stop smoking. If toxicity symptoms occur while a patient is using combination NRT, advise them to reduce the fast- or medium-acting NRT before considering removal of the patch.

Correct use of nicotine replacement therapy—patient information outlines management of other adverse effects specific to different formulations. Varenicline or bupropion can be added to combination NRT, but this is not generally required if NRT is used at adequate dosages with correct technique.

Offer a repeat course of combination NRT to anyone who wishes to continue beyond the first 12-week course, regardless of whether their smoking has reduced. No maximum duration of therapy is specified; longer durations up to 6 months are more effective for long-term smoking managementThe Royal Australian College of General Practitioners (RACGP), 2021. Some patients require indefinite NRT to prevent relapses. The impact of long-term replacement is not clear; possible risks of microvascular damage from vasoconstriction must be balanced against harms of continued smoking.

Note: For effective NRT, recommend adequate dosages of combination NRT for a minimum of 12 weeks. Extended therapy may increase abstinence rates and reduce risk of relapse.

If completing treatment, combination NRT can be tapered or stopped abruptly, depending on patient preferenceThe Royal Australian College of General Practitioners (RACGP), 2021.