Augmented Doses of Nicotine Replacement Therapy: Feasibility for Dual Cigarette and E-cigarette Cessation.

Abstract

Introduction: Dual use of combustible cigarettes (CC) and e-cigarettes (EC) is common and has harmful health effects. Many who dual use want to quit, but there are no empirically supported dual cessation interventions. High dose nicotine replacement therapy (NRT) is effective for treating heavy smoking and may be applied to treating dual use of CC and EC.

Methods: In this pilot feasibility trial, individuals using both CC and EC who wanted to quit were randomly assigned to a 28-day supply of NRT in one of three doses: Standard (21mg patch, qd + 4mg lozenge prn [minimum of 5, up to 20/day]); Mid (21mg patch + 14mg patch + 4mg lozenge [5-30/day]), or High (2 × 21mg patches + 4mg lozenges [5-40/day]). Participants reported CC and EC use daily throughout treatment and 1-month follow-up.

Results: Participants enrolled in the study (N=46 from 2023-2024, analyzed 2025) had high nicotine dependence and most completed study procedures. Participants in the Mid group reported using NRT on more days relative to the other groups. Participants in Mid and High reported numerically higher 7-day point-prevalence dual abstinence at end of treatment (13% for both groups vs 6% Standard) and follow-up (33% for both groups vs 0% Standard). GEE models showed a significantly higher likelihood of abstinence on a given day for the Mid and High groups relative to Standard (ps<.05).

Conclusions: Augmented doses of NRT are a feasible, promising treatment for dual cessation of CC and EC. Future research should evaluate this approach in a more rigorous, fully powered trial.