How-to · U.S. OTC label · Updated October 2, 2026
What nicotine patch dose should I start with?
Direct answer
More than 10 cigarettes a day: start 21 mg (Step 1) for 6 weeks, then 14 mg for 2 weeks, then 7 mg for 2 weeks — 70 patches over 10 weeks. 10 or fewer: start 14 mg (Step 2) for 6 weeks, then 7 mg for 2 weeks — 56 patches over 8 weeks. A pack a day (20) uses the 21 mg plan.
Starting dose by cigarettes per day
| How much you smoke | OTC start | Label plan |
|---|---|---|
| 1–9 cigarettes/day | 14 mg (Step 2) | 14 mg × 6 wk → 7 mg × 2 wk |
| 10 cigarettes/day (½ pack) | 14 mg (Step 2) | 14 mg × 6 wk → 7 mg × 2 wk |
| 11–20 cigarettes/day (up to 1 pack) | 21 mg (Step 1) | 21 mg × 6 wk → 14 mg × 2 wk → 7 mg × 2 wk |
| 21–39 cigarettes/day | 21 mg (Step 1) | 21 mg × 6 wk → 14 mg × 2 wk → 7 mg × 2 wk |
| 40+ cigarettes/day (2 packs) | 21 mg (Step 1) | 21 mg × 6 wk → 14 mg × 2 wk → 7 mg × 2 wk |
Source: NicoDerm CQ Drug Facts. Exactly 10 cigarettes a day is the 14 mg start. Five or fewer still starts at 14 mg; the label has no 7 mg starting step.
What each step means
| 24-hour patch | Step | When it is used |
|---|---|---|
| 21 mg / 24 h | Step 1 | More than 10 cigarettes a day — weeks 1–6 |
| 14 mg / 24 h | Step 2 | 10 or fewer a day — weeks 1–6; heavier smokers weeks 7–8 |
| 7 mg / 24 h | Step 3 | Final 2 weeks for everyone |
16-hour patches use 15 mg, 10 mg, and 5 mg instead of 21, 14, and 7. Wear a 24-hour patch overnight if morning cravings are the problem; take it off at bedtime if it causes vivid dreams.
Gum or lozenges with the patch
If the first cigarette is within 30 minutes of waking, OTC gum and lozenge labels use the 4 mg strength. If it is later, they use 2 mg. Combination therapy is common; a pharmacist or 1-800-QUIT-NOW can set a daily limit.
Limits
- One OTC patch at a time. Do not cut a patch. Doses above 21 mg (28–42 mg for heavier smoking in Mayo Clinic protocols) need a clinician.
- Ask a doctor before use in pregnancy, under age 18, or with heart disease, a recent heart attack, an irregular heartbeat, or uncontrolled high blood pressure.
- Stop and get help for nausea, vomiting, dizziness, weakness, or a racing heartbeat.
- This page restates public label rules. It is not a personal prescription.
Use the calculator
What 21 mg replaces in cigarettes: how many cigarettes is a 21 mg patch? Enter your count in the nicotine patch dosing calculator. Free coaching: 1-800-QUIT-NOW.