Which nicotine replacement therapy is most appropriate for a 38-year-old man with a smoking history of 10 pack-years who smokes 20 cigarettes daily?

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The most appropriate choice is based on the intensity of nicotine dependence indicated by the individual's smoking history. In evaluating nicotine replacement therapy options, it is crucial to match the dose of nicotine replacement with the level of nicotine intake from smoking.

For this individual, who has a smoking history of 20 cigarettes daily, using the nicotine patch can be an effective way to manage withdrawal symptoms and help in smoking cessation. The 21-mg nicotine patch is ideal in this case because this dosage is often recommended for individuals who smoke more than 10 cigarettes a day, as it provides sufficient nicotine coverage to alleviate withdrawal symptoms. The regimen that includes transitioning to lower doses (the 14-mg patch followed by the 7-mg patch) is a well-structured approach to tapering off nicotine, which can help mitigate cravings as the individual reduces their dependence.

By starting with the 21-mg patch for the first two weeks, the individual is likely to achieve better adherence and success in quitting smoking, as it addresses the higher level of dependence. Gradually reducing the dose over the subsequent weeks helps in transitioning away from nicotine dependence in a controlled manner, which can enhance the likelihood of long-term cessation.

Furthermore, this plan does not abruptly stop nicotine use, which can

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