Plain English Summary
Background and study aims
Nicotine replacement treatment (NRT) is widely used to help people quit smoking, but it’s not effective for everyone. This may be, in part, because many smokers receive less nicotine from NRT than smoking. There is some evidence that higher dosing and the use of NRT before actually quitting smoking may help. This is because nicotine from NRT may weaken the association between smoking behaviour and the nicotine reward from cigarettes, and in turn reduce the desire to smoke. A potentially promising approach would be to increase the NRT dose before quitting, with the aim of achieving nicotine levels which make smoking unrewarding or even unpleasant. The aim of this study is to examine the acceptability, safety, and potential efficacy of an personalized program which increases NRT (iNRT) dosing to help people quit smoking.
Who can participate?
Adult smokers who want to quit and are willing to use nicotine patches.
What does the study involve?
All participants are given nicotine patches to use for four weeks before their target quit date and for four weeks afterwards. In the four weeks before they quit, the dose of nicotine patches is increased every week if the smoker does not report any side effects, such as feeling sick. The maximum dose given can be up to 84mg/day. Over the four weeks after the quit date, the patch dose is reduced to standard levels (21mg/day). The number of participants who progress through each stage of the dosing schedule are recorded as well as those who are sticking to the treatment. In addition, participants are interviewed about changes in smoking rate and enjoyment of smoking, withdrawal symptoms, and the quit rate at 4 weeks after the target quit date.
What are the possible benefits and risks of participating?
Participants may benefit from being able to successfully quit smoking. there are no notable risks involved with participating. If participants experience any severe side effects from the nicotine patch, they will be asked to either stop altogether or reduce the dose.
Where is the study run from?
Emphysema Foundation (Argentina)
When is the study starting and how long is it expected to run for?
December 2016 to August 2018
Who is funding the study?
Global Research Awards for Nicotine Dependence (UK)
Who is the main contact?
1. Dr Dunja Przulj (scientific)
2. Dr Luis Wehbe (scientific)
Dr Dunja Przulj
Health and Lifestyle Research Unit
Queen Mary University of London
2 Stayner's Road
Dr Luis Wehbe
Carlos Alvear 3345
Mar del Plata
Version 1.1 10 Oct 2016
Increasing the dose of Nicotine Replacement Treatment to individual needs: A pilot study
The aim of this study is to examine the feasibility and acceptability of increasing the dose of nicotine patches used prior to a smokers target quit date (TQD) in order to establish what proportion of smokers are likely to progress to different levels of dose increase and what, if any, side effects they may report.
Joint Commission on Health Research (Comisión Conjunta de Investigación en Salud- CCIS), Beunos Aires, Argentina, 24/01/2017, ref: 2919/1419/2016
Open-label single-site non-randomised pilot study
Primary study design
Secondary study design
Non randomised study
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Smokers wanting to give up will be given nicotine patches to use for 4 weeks prior to their target quit day and for 4 weeks during their quit attempt. In the four weeks prior to their target quit day, the dose of nicotine patches will increase each week if the smoker does not report any reaction to it (e.g. nausea). The maximum dose used could be up to 84mg/day (i.e. the participant would wear 4 patches a day). Over the 4 weeks after the quit day, the patch dose will be reduced to standard levels (21mg/day, i.e. 1 patch per day). The total duration of the intervention is 8 weeks. There is no further follow-up of participants after this.
21mg/24hr Nicotine Transdermal Patch
Primary outcome measure
Feasibility of the intervention is assessed by recording the proportion of participants who progress through each stage of increased dosage (42mg, 63mg and 84mg) over the four weeks prior to their Target Quit Day.
Secondary outcome measures
1. Adherence to treatment will be assessed by examining the frequency of patch use over the 8 weeks and the number of participants who stop using their patches over the 8 weeks
2. Acceptability and helpfulness of the intervention will be measured by asking participants to rate (1-5) how helpful they found their patch over the last week, at each session; and by looking at the frequency of any adverse effects and their intensity
3. Potential efficacy of the intervention will be measured by examining validated abstinence rates at the end of the 8 weeks, changes in carbon monoxide readings, cigarette consumption, enjoyment of smoking and withdrawal symptoms over the first 4 weeks prior to the TQD; and changes in withdrawal symptoms over the 8 weeks
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Aged 18-65 years of age
2. Daily smoker
3. Seeking treatment to quit smoking and willing to use nicotine patches
Target number of participants
Total final enrolment
Participant exclusion criteria
1. Pregnant/breastfeeding or planning to conceive in the next 3 months
2. Previous adverse reaction to the nicotine patch
3. Serious medical condition including, cancer and psychiatric illness
4. History of Myocardial infarction
5. Cannot read, write or understand Spanish
6. Current involvement in other interventional research
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Emphysema Foundation (Fundación Enfisema)
Carlos Alvear 3345 Mar del Plata
Global Research Awards for Nicotine Dependence (GRAND)
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Planned publication in a high-impact peer reviewed journal
IPD Sharing plan:
The datasets generated during and/or analysed during the current study are/will be available upon request from Dr Dunja Przulj, email@example.com
Intention to publish date
Participant level data
Available on request
Basic results (scientific)
2019 results in: https://www.ncbi.nlm.nih.gov/pubmed/30370685 (added 06/08/2019)