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Quick answer
More than 10 cigarettes a day: start the 21 mg patch (Step 1) for 6 weeks, then 14 mg for 2 weeks, then 7 mg for 2 weeks. 10 or fewer: start 14 mg (Step 2) for 6 weeks, then 7 mg for 2 weeks. Apply one patch every 24 hours. A 21 mg patch supplies about as much nicotine as 21 cigarettes (one pack) a day.
Last updated: October 1, 2026. Free help: call 1-800-QUIT-NOW (1-800-784-8669) or visit smokefree.gov. Guides: which patch to start · 21 mg vs cigarettes.
1 pack = 20 cigarettes. Use your average day.
Starting patch
21 mg / 24 h
Step 1 · 10-week plan · 70 patches
Based on: NicoDerm CQ Drug Facts (U.S. OTC label)
| Step | Patch | Weeks | Patches |
|---|---|---|---|
| Step 1 | 21 mg | Weeks 1–6 | 42 |
| Step 2 | 14 mg | Weeks 7–8 | 14 |
| Step 3 | 7 mg | Weeks 9–10 | 14 |
That's 5 boxes of 14 patches. If you need longer than the plan to stay smoke-free, the label says to talk to your health care provider.
Nicotine from your cigarettes
About 20 mg absorbed per day (range 8–32 mg at ~1 mg per cigarette) vs. 21 mg/day from the patch.
For breakthrough cravings
Patch + 4 mg nicotine gum or lozenge (combination NRT) works better than the patch alone. Ask a pharmacist how to combine them.
Education only. Ask a doctor first if you are pregnant, under 18, or have heart disease or uncontrolled blood pressure. Remove the patch and get help for nausea, vomiting, dizziness, or a racing heartbeat.
The label column is what the OTC box tells you to do. The Mayo Clinic column is the higher-dose range its Nicotine Dependence Center uses under clinician supervision.
| You smoke | Start (label) | Label taper | Mayo Clinic range |
|---|---|---|---|
| 1–9 cigarettes/day | 14 mg (Step 2) | 14 mg × 6 wk → 7 mg × 2 wk | 14 mg/day |
| 10 cigarettes/day (½ pack) | 14 mg (Step 2) | 14 mg × 6 wk → 7 mg × 2 wk | 14–21 mg/day |
| 11–20 cigarettes/day (up to 1 pack) | 21 mg (Step 1) | 21 mg × 6 wk → 14 mg × 2 wk → 7 mg × 2 wk | 14–21 mg/day |
| 21–39 cigarettes/day | 21 mg (Step 1) | 21 mg × 6 wk → 14 mg × 2 wk → 7 mg × 2 wk | 28–35 mg/dayClinician only — above one patch |
| 40+ cigarettes/day (2 packs) | 21 mg (Step 1) | 21 mg × 6 wk → 14 mg × 2 wk → 7 mg × 2 wk | 42 mg/dayClinician only — above one patch |
From the NicoDerm CQ label. One patch per day.
| Step | Strength | Weeks | Patches |
|---|---|---|---|
| Step 1 | 21 mg / 24 h | 1–6 | 42 |
| Step 2 | 14 mg / 24 h | 7–8 | 14 |
| Step 3 | 7 mg / 24 h | 9–10 | 14 |
| Step | Strength | Weeks | Patches |
|---|---|---|---|
| Step 2 | 14 mg / 24 h | 1–6 | 42 |
| Step 3 | 7 mg / 24 h | 7–8 | 14 |
Mayo Clinic’s alternative for clinician-led plans: after 4–6 weeks smoke-free, step down 7–14 mg every 2–4 weeks as tolerated.
At about 1 mg of nicotine absorbed per cigarette (Benowitz & Jacob). Real intake ranges from roughly 0.4 to 1.6 mg per cigarette depending on how you smoke.
| Patch per day | ≈ Cigarettes | ≈ Packs |
|---|---|---|
| 7 mg | 7 | 0.35 |
| 14 mg | 14 | 0.7 |
| 21 mg | 21 | 1.05 |
| 28 mg(Rx combo) | 28 | 1.4 |
| 35 mg(Rx combo) | 35 | 1.75 |
| 42 mg(Rx combo) | 42 | 2.1 |
A 21 mg patch produces average blood nicotine levels about half those of heavy smoking, which is why some heavy smokers still have cravings and do better with patch + gum or lozenge.
| 24-hour patch | Step | Who uses it | 16-hour equivalent |
|---|---|---|---|
| 21 mg / 24 h | Step 1 | More than 10 cigarettes a day — weeks 1–6 | 15 mg / 16 h |
| 14 mg / 24 h | Step 2 | 10 or fewer a day — weeks 1–6; heavier smokers weeks 7–8 | 10 mg / 16 h |
| 7 mg / 24 h | Step 3 | Final 2 weeks for everyone | 5 mg / 16 h |
U.S. patch labels only cover cigarettes, so these are clinical-judgment starting points. Recheck after 1–2 weeks: if cravings persist, the dose is probably too low; nausea or vivid dreams can mean it's too high.
| Smokeless tobacco use | Patch dose (Mayo Clinic) |
|---|---|
| Under 2 cans or pouches per week | 14 mg/day |
| 2–3 cans or pouches per week | 21 mg/day |
| More than 3 cans or pouches per week | 42 mg/day (two 21 mg patches, clinician only) |
The patch covers background nicotine; gum or lozenges handle sudden cravings. Combination NRT works better than any single form. Choose the strength by when you first smoke: 4 mg if within 30 minutes of waking, 2 mg if later. Used alone, the lozenge label schedule is:
| Weeks 1–6 | 1 lozenge every 1–2 hours |
| Weeks 7–9 | 1 lozenge every 2–4 hours |
| Weeks 10–12 | 1 lozenge every 4–8 hours |
Start 21 mg (Step 1) → 21 mg × 6 wk → 14 mg × 2 wk → 7 mg × 2 wk · 70 patches
Add 4 mg gum or lozenges for breakthrough cravings.
Start 14 mg (Step 2) → 14 mg × 6 wk → 7 mg × 2 wk · 56 patches
Add 2 mg gum or lozenges for breakthrough cravings.
Start 21 mg (Step 1) → 21 mg × 6 wk → 14 mg × 2 wk → 7 mg × 2 wk · 70 patches
With a clinician: 42 mg/day (two 21 mg patches).
Add 4 mg gum or lozenges for breakthrough cravings.
Start 21 mg (Step 1) → 21 mg × 6 wk → 14 mg × 2 wk → 7 mg × 2 wk · 70 patches
Add 4 mg gum or lozenges for breakthrough cravings.
See how much smoking has added up with the pack-year calculator.
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