Combination NRT

Some smoking cessation medications can be used together to improve the chances of quitting and staying quit. Combination nicotine replacement therapy (NRT) uses both a long-acting and a short-acting nicotine medication to support tobacco cessation, making it easier to manage withdrawal symptoms and cravings during a quit attempt.

Illustration of a nicotine patch, nicotine lozenges and nicotine gum

Combination NRT is effective for adults trying to quit smoking, including those who smoke heavily, use smokeless tobacco, have experienced relapse in the past, or have psychiatric comorbidities.

How Combination NRT works

Using two forms of NRT together provides more complete relief from nicotine withdrawal and cravings than using a single NRT medication alone:

  • Long Acting: The nicotine patch provides a steady dose of nicotine throughout the day to decrease withdrawal symptoms.
  • Short Acting: The nicotine gum and lozenges* provide nicotine more rapidly and can be used when cravings occur.

How to get started

  • Talk with your healthcare provider if you have questions about combination NRT.
  • Nicotine gum, nicotine lozenges, and nicotine patches are available over the counter, without a prescription. 
  • Even though available over the counter, many health plans, including Medicaid, will cover these medications when prescribed by a healthcare provider. 

Dose and Schedule

Nicotine Patch

  • At the same time each day, place a new patch on an area of clean, dry skin above the waist, such as the upper arm, shoulder, chest, or back.
  • Use the nicotine patch every day:
    • Start with the 14 mg patch if you smoke fewer than 10 cigarettes a day.
    • Start with the 21 mg patch if you smoke 10 or more cigarettes a day.
  • Change the nicotine patch every 24 hours
  • Continue treatment for at least 12 weeks. After 6 weeks, consider gradually reducing the patch strength as cravings and withdrawal symptoms decrease.

Nicotine Gum or Lozenge

  • Use 1 piece of gum or 1 lozenge every 1 to 2 hours as needed for cravings.
    • 2 mg if you smoke your first cigarette more than 30 minutes after waking up.
    • 4 mg if you smoke your first cigarette within 30 minutes of waking up.
  • Do not use more than 24 pieces of gum or 20 lozenges in one day.

Side Effects

  • The same side effects experienced with individual NRT may occur when using combination NRT, including skin irritation, sleep disturbances or vivid dreams, headache, dizziness, and nausea.
  • Before starting combination NRT, review the side effects, precautions, and instructions for each medication being used.
  • Many side effects can be managed by lowering the medication dose or how the medication is used.
  • If side effects persist or become bothersome, contact your healthcare provider.

*The nicotine nasal spray and nicotine inhaler have also been approved by the FDA for smoking cessation but are uncommonly used and often not readily available.

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