What is the most effective nicotine replacement therapy?
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No single nicotine replacement therapy is most effective for all smokers. All forms of nicotine replacement therapy (gum, transdermal patch, spray, inhaler, and lozenge) are equally effective, increasing smoking cessation rates by about 150% to 200%. A Cochrane Review found that 17% of smokers who had used nicotine replacement therapy successfully quit at follow-up vs 10% of smokers in the control group. Except in special circumstances (medical contraindications, smoking <10 cigarettes daily, pregnancy, or breastfeeding), all smokers attempting to quit should be offered nicotine replacement therapy (strength of recommendation [SOR]: A). Higher doses of nicotine gum or lozenge (4 mg vs 2 mg) increase quit rates in heavy smokers. Use of high-dose patches (>21 mg) may benefit heavy smokers or those relapsing due to nicotine withdrawal (SOR: B). For relapsed smokers, combination therapy improves long-term abstinence rates (estimated abstinence 28.6% vs 17.4% for monotherapy) (SOR: B).