1. The goal is complete substitution
2. NVPs should be used to prevent nicotine cravings.
3. Patients will self-titrate.
4. Cartridge consumption should be monitored.
5. Pharmacists should acknowledge a reduction in cartridge usage.
6. Some patients reduce the frequency of use over time without prompting.
7. Pharmacists should acknowledge and affirm the number of days that patients are smoke-free. (Most patients using other pharmacotherapies never make it past 30 days without a cigarette.)

Repeat prescriptions / ongoing support

Counsel

Repeat scripts: Patient support and retention are essential after presenting their initial script.

• Communication is vital – advise the patient that the initial script is only a start.
• If dispensed less than a 7-pack of Nicovape® Q cartridges, advise that they are likely to need repeats within a week.
• Counsel the importance of working with you to ensure they have sufficient Nicovape® Q cartridges to avoid running out, which may risk relapse to smoking or purchasing poor-quality NVPs from the illegal black market.
• You should keep your patient’s script on file and ensure you have stock on hand when they need to fill their next repeat, which could be within a week.

Monitor

Monitor cartridge consumption: Ask your patient about their consumption over the last month or since their last script.

• Patients’ overall cartridge consumption may reduce over time as they self-titrate more effectively.
• Highlight any observed reductions to the patient as significant progress on their quit journey.

Monitor the number of smoke-free days: Establish the number of days since your patient has had a cigarette. Reinforce the patient’s efforts by asking:

• Is this the longest they have been smoke-free?
• Have they noticed any positive responses to being smoke-free? Improved sense of smell/taste? More energy? Better sleep?

Assess

Assess concentration and flavour compatibility: To ensure your patient adheres to their NVP therapy, conduct a follow-up assessment when they present for repeat scripts to identify whether:

• They are happy with the flavour of choice; and/or
• They are experiencing any adverse events, such as persistent cough, nausea, excessive dizziness, headaches or intermittent diarrhoea. If so, suggest that the patient contact their prescribing doctor, who may adjust their treatment plan.

Acknowledge

Acknowledgement & Recognition: Based on your assessment of the behavioural support points above, if you find your patient has reduced their reliance upon nicotine and has been smoke-free for some time, congratulate them on their efforts – this will be critical to ensure they remain committed to achieving nicotine abstinence.

Additionally, reinforcing to your patient that they are gradually reducing their dependence on nicotine and associated patterns of behaviour will help them develop a sense of agency, where previously they’ve had none.