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Sample NRT Prescription

The document outlines a prescription plan for a patient ready to quit smoking, detailing the use of nicotine patches and chewing gum to aid in cessation. The patient is advised to start medication on a planned quit date and to employ behavioral methods to manage cravings. Follow-up reviews are scheduled to assess progress and adjust treatment if necessary.

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Mohammad Esmat
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45 views1 page

Sample NRT Prescription

The document outlines a prescription plan for a patient ready to quit smoking, detailing the use of nicotine patches and chewing gum to aid in cessation. The patient is advised to start medication on a planned quit date and to employ behavioral methods to manage cravings. Follow-up reviews are scheduled to assess progress and adjust treatment if necessary.

Uploaded by

Mohammad Esmat
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Sample NRT Prescription

COMPLAINTS:
Working on quitting smoking. Smokes >20 cigs/day, early morning smoking+. Ready to quit. Planned
Quit date: …………………………

DIAGNOSES:
(Medical diagnoses + Z72.0 - Tobacco use (Remarks: for aiding tobacco cessation)

MEDICATION/TREATMENT:
Nicotine patches - 21mg one patch LA per day for 4 weeks. Apply patch on waking up in the
morning. Next morning remove and apply new patch onto a different site.

Nicotine chewing gum 4mg gum ( TM0434 2baconil ) / 2mg gum – 1-2 chewing gum PRN when urge
/cravings occur, after first trying behavioural methods. Max 12/day for 2 weeks - 168 pieces

ADVICE:
Start all medicines and stop smoking on planned Quit date. Throw all cigarettes, lighter and ashtrays,
and any souvenirs with brand logos before Quit date. For cravings, first trying behavioural methods
as an alternative to smoking, such as Delaying, drinking water, Deep breathing, Exercise, Calling
someone supportive, prayer, etc. If cravings cannot be controlled, only then take chewing gum.

PLAN:
Nicotine patches:

--> 21 mg one patch LA per day for 4 weeks.

--> then 14mg patch, 1 patch per day for 2 weeks,

--> then 7mg patch, 1 patch per day for 2 weeks, then stop.

Nicotine chewing gum: SOS for cravings, taper as cravings reduce.

REVIEW 1 week after quitting, then monthly, to assess progress / any need for adjusting medication
or behavioural methods. Review SOS earlier if about to relapse.

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