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June 26, 1996

Do Heavy Smokers Need a Higher Replacement Dose of Nicotine to Quit?-Reply

Author Affiliations

University of Wisconsin Medical School Madison
Mayo Clinic Rochester, Minn

JAMA. 1996;275(24):1882-1883. doi:10.1001/jama.1996.03530480024028

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In Reply.  —Drs Westman and Rose raise important concerns aimed at the therapeutic usefulness of the 44-mg nicotine patch dose compared with the 22-mg dose. We confess to being surprised ourselves, as intuitively we expected a larger dose might be more effective, just as we expected more intensive behavioral intervention would be more effective; neither produced a long-term efficacious advantage. The 44-mg dose showed higher efficacy in the minimum intervention group at 4 weeks (which was the duration of the 44-mg dose), but did not produce sustained benefit relative to the 22-mg dose.Westman and Rose cite research on 2- and 4-mg nicotine gum as a reason for expecting a doubling of the patch dose to be effective. The many differences between nicotine patches and gum (eg, route of administration, lower amount of nicotine per dose, self-dosing, and pharmacokinetics) make it difficult to compare the 2 products.While it may