Start with Step 1 in nicotine replacement therapy for patients who smoke how many cigarettes per day?

• A. 10 or more
• B. 5 or more
• C. 1 to 4
• D. None

Answer: (A)

Starting nicotine replacement therapy uses a tiered approach based on how many cigarettes a person smokes each day. Heavier smoking means greater nicotine dependence, so the starting dose needs to be strong enough to prevent withdrawal and cravings. For patients who smoke ten or more cigarettes daily, begin with the higher-dose level of NRT. This is because a higher starting dose better controls withdrawal symptoms and cravings in more dependent smokers, making it easier to stick with cessation efforts. In contrast, lighter smokers—such as those who smoke fewer than ten per day—would typically start at a lower dose to avoid excessive nicotine exposure. If someone doesn’t smoke at all, NRT isn’t indicated.