Tobacco Cessation Medication Orders (Adult)
ANOTHER GENERICALLY EQUIVALENT PRODUCT WITHIN THE APPROVED FORMULARY MAY BE ADMINISTERED FOR DRUGS ORDERED UNLESS CHECKED
Confirm that the patient has no known allergies or contraindications to the therapy ordered below.
For patients receiving nicotine replacement therapies, provide patient education that no further tobacco intake should occur one
the nicotine replacement product(s) are started. (Note: patch may be used with gum or lozenge)
Nicotine pharmacologic therapy
Nicotine Patch – (OTC [7 mg, 14 mg and 21 mg]; may be removed at night to prevent insomnia)
≥ 40 cpd: 42 mg/day
≥ 3 smokeless cans or pouches/week: 42 mg/day
21-39 cpd: 28-35 mg/day
2-3 smokeless cans or pouches/week: 21 mg/day
10-20 cpd: 14-21 mg/day
≤ 2 smokeless cans or pouches/week: 14 mg/day
≤ 10 cpd: 14 mg/day
 Adjust based on withdrawal symptoms, urges and comfort. After 4-6 weeks of tobacco abstinence, taper every 2-4 weeks in
7-14 mg steps as tolerated.
Nicotine Lozenge – (OTC [ 2 mg and 4 mg]; may use PRN in conjunction with the nicotine patch; max 20 lozenges/24H)
≥ 20 cpd: 4 mg; 1-2 lozenges every 1-2 hours; min 9/day
≥ 3 smokeless cans or pouches/week: 4 mg
≤ 20 cpd: 2 mg; 1-2 lozenges every 1-2 hours; min 9/day
≤ 3 smokeless cans or pouches/week: 2 mg

Based on time to first cigarette of the day:
≤ 30 minutes after waking: 4 mg
≥ 30 minutes after waking: 2 mg
Nicotine Gum - (OTC [ 2 mg and 4 mg]; may use PRN in conjunction with the nicotine patch; max 24 pieces/24H)
≥ 20 cpd: 4 mg; 1-2 pieces every 1-2 hours; 10-12 pieces/day
≤ 20 cpd: 2 mg; 1-2 pieces every 1-2 hours; 10-12 pieces/day

Based on time to first cigarette of the day:
≤ 30 minutes after waking: 4 mg
≥ 30 minutes after waking: 2 mg
Nicotine Nasal Spray – (Rx; not recommended for smokeless tobacco)
1 spray in each nostril; 1-2 times/hour (up to 5 times/hour or 40 times/day); Most average 14-15 doses/day initially
Nicotine Inhaler – (Rx; not recommended for smokeless tobacco)
Minimum of 6 cartridges/day; up to 16/day
Combination Nicotine Replacement Therapy (NRT)
Dose the patch as prescribed. Prescribe 2 mg gum or lozenge, nicotine inhaler or nasal spray for Ad Lib use every 1-2 hours
as needed. Adjust dose of patch upward if unusually frequent use of immediate release NRT is needed. Goal is to minimize
need for short-acting NRT dosing.
Non-nicotine pharmacologic therapy
 Must be prescreened and observed for neuropsychiatric symptoms (hostility, agitation, depression, etc.)
Bupropion SR (Zyban) - (Rx; generic available); (may combine with patch to increase abstinence rate)
150 mg/day X 3 days; then 150 mg BID (at least 8 hours apart); continue with 150 mg BID for 12 weeks
Varenicline (Chantix) – (Rx; monitor neurological changes; most common side effects are nausea & insomnia)
 Start medication one week prior to quit date
 TAKE WITH FOOD
Initial: 0.5 mg/day on days 1-3; then 0.5 mg BID on days 4-7
ON TQD, STOP SMOKING; 1.0 mg BID X 11 weeks
May continue at 1.0 mg BID for additional 12 weeks
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Authorized Signature
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Date
Oklahoma Hospital Association 2015
Adapted from Mayo Clinic NDC Tobacco Dependence Treatment Medication Summary