What strength of nicotine gum should a patient use if they smoke their first cigarette within 30 minutes of waking?

For individuals who smoke their first cigarette within 30 minutes of waking, it is recommended to use a higher strength of nicotine replacement therapy, specifically 4 mg of nicotine gum. This recommendation is based on the concept of nicotine dependence, which is often assessed by the time to first cigarette after waking. Those who smoke within the first half hour are typically more dependent on nicotine and may require a higher dose to effectively manage withdrawal symptoms and cravings.

Using a lower strength, such as 2 mg, might not suffice for these individuals, as it may not provide adequate nicotine to alleviate cravings and withdrawal symptoms linked to their higher level of dependence. The 4 mg option is designed to address these needs and help facilitate a more successful quit attempt by providing sufficient nicotine while minimizing side effects associated with excessive dosing. Hence, patients who are more reliant on nicotine due to their early morning smoking habits are advised to start with the 4 mg gum to increase their chances of quitting successfully.