This is the text extract for Notification on prescribing Nicotine Replacement Therapy, browse documents here.

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21 January 2011

Dear prescriber, Prescribing Nicotine Replacement Therapy (prescriptions and Quitcards) The maximum dispensing rules for funded nicotine replacement therapy (NRT) were removed from 1 January 2011. This change appears to have resulted in uncertainty among some healthcare providers about quantities that should be written on prescriptions or Quitcards. Prescribers and Quitcard providers must indicate the total quantity or period of supply, and include a dose and frequency, on all prescriptions and Quitcards issued to patients. This is necessary to comply with regulation 41 of the Medicines Regulations 1984. As a guide for prescribers and Quitcard providers, the Medsafe datasheet recommended doses for the currently funded (Habitrol) brand of NRT are summarised in the table below. Please refer to the Medsafe datasheets http://www.medsafe.govt.nz/profs/Datasheet/ for more detailed information.

Nicotine product Recommended frequency per day Recommended dosing schedule People smoking more than 20 cigarettes a day should start with the 21 mg patch; those smoking less than 20 cigarettes a day should start with the 14 mg patch. People starting on the 21 mg patch should use this strength for 3 to 4 weeks, before moving onto the 14 mg patch for 3 to 4 weeks, and then the 7 mg patch for 3 to 4 weeks. People starting on the 14 mg patch may switch to the 7 mg patch after 3 to 4 weeks, or continue to use the 14 mg patch for 6 to 8 weeks before moving onto the 7 mg patch for 3 to 4 weeks. People smoking more than 20 cigarettes a day, as well as people who have failed to quit smoking when using the 2 mg gum, should use the 4 mg strength. Otherwise, the 2 mg strength should be used. After three months, users should gradually cut down the number of gum used each day until only 1-2 pieces of gum per day are required, at which time they should stop using the product.

21 mg patch 14 mg patch 7 mg patch

1 patch 1 patch 1 patch

4 mg gum 2 mg gum

4–6 pieces of gum (max 10) 8–12 pieces of gum (max 20)

A403388 - qA19567

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Nicotine product

Recommended frequency per day 8–12 lozenges (max 15) 8–12 lozenges (max 25)

Recommended dosing schedule People smoking more than 20 cigarettes a day, as well as people who have failed to quit smoking when using the 1 mg lozenge, should use the 2 mg lozenge. Otherwise, the 1 mg strength should be used. After three months, users should gradually cut down the number of lozenges used each day until only 1-2 lozenges per day are required, at which time they should stop using the product

2 mg lozenge 1 mg lozenge

Combination therapy Different maximum quantities of Habitrol apply for people who are taking gum or lozenges in addition to patches. The Medsafe datasheet recommended combination therapy doses, frequency and maximum quantities are outlined in the table below. Please refer to the Medsafe datasheets http://www.medsafe.govt.nz/profs/Datasheet/ for more information on combination dosing.

Nicotine product combination Recommended frequency of gum or lozenge per day Recommended length of therapy Maximum of 12 weeks followed by either:  Stopping use of 21 mg patch plus gradual decline in use of gum until no longer needed; OR  Continuing with 14 mg patch for 3–4 weeks, then 7 mg patch for 3–4 weeks, maintaining recommended gum frequency per day, throughout. Frequency of gum use can then decline until no longer needed. Maximum of 12 weeks followed by either:  Stopping use of 21 mg patch plus gradual decline in use of lozenge until no longer needed; OR  Continuing with 14 mg patch for 3–4 weeks, then 7 mg patch for 3–4 weeks, maintaining recommended lozenge frequency per day, throughout. Frequency of lozenge use can then decline until no longer needed.

21 mg patch and 2 mg gum

1 patch and 4–12 pieces of gum (max 12)

21 mg patch and 1 mg lozenge

1 patch and 4–12 lozenges (max 12)

Note that Habitrol nictotine patches are not recommended for use with Habitrol 4 mg gum or 2 mg lozenges. Yours sincerely

Dr Peter Moodie Medical Director

A403388 - qA19567