Nicotine Replacement Therapy Guidelines for Hospitalized Smokers

Initial Assessment and Dosing

• The American Thoracic Society recommends assessing smoking status of all patients on admission and advising smokers about the hospital's smoke-free policy 4
• For patients who smoke ≥10 cigarettes per day, the American College of Cardiology recommends starting with a 21 mg/24-hour nicotine patch 1, 3
• For lighter smokers (<10 cigarettes per day), consider starting with a lower dose patch (14-15 mg) as suggested by the American Heart Association 3

Combination Therapy Approach

• The American College of Cardiology recommends combining the nicotine patch with a short-acting NRT form for optimal effectiveness 1, 2, 3
• Short-acting options include nicotine gum (2 mg or 4 mg), nasal spray, or inhalator as recommended by the American Thoracic Society 3, 4
• Combination NRT has shown superior abstinence rates (36.5% at 6 months) compared to monotherapy according to the Mayo Clinic 5, 2

Administration Instructions

• Apply the patch to clean, dry, hairless skin on the upper body or outer arm each morning as instructed by the American College of Cardiology 3
• Rotate application sites daily to prevent skin irritation as recommended by the American Heart Association 3

Duration and Follow-up

• Continue NRT for a minimum of 12 weeks for the initial quit attempt as recommended by the American College of Cardiology 1, 2, 3
• Schedule first follow-up within 2 weeks after starting pharmacotherapy according to the American Heart Association 1, 2

Safety Considerations

• NRT appears safe for patients with cardiovascular disease, though package inserts may advise consultation with a healthcare provider as noted by the Mayo Clinic 5, 4
• Common side effects include local skin reactions, nausea, vomiting, sweating, mood changes, and sleep disturbances as reported by the American College of Cardiology 5, 1

Behavioral Support Components

• Provide at least 4 sessions of behavioral therapy during each 12-week course of pharmacotherapy as recommended by the American College of Cardiology 2
• Include skills training, social support, and motivational interviewing in behavioral therapy according to the American Heart Association 2

Special Populations

• For pregnant smokers, consultation with an obstetrician is recommended before initiating NRT as suggested by the American Thoracic Society 4, 3
• Some NRT products are not recommended for people under 18 years of age as noted by the American Academy of Pediatrics 4, 3