tobacco cessation. In addition, behavioral interventions such as in-person counseling, telehealth services, and self-help programs have been shown to further improve tobacco cessation rates. Nicotine gum is often used in conjunction with a long-acting nicotine patch. The patch delivers nicotine slowly and consistently throughout the day to achieve a stable level of nicotine in the blood, and the short-acting gum is used as needed to provide immediate relief of breakthrough cravings and withdrawal symptoms. Side effects and adherence rates of using the gum and patch together are similar to using either NRT alone. Dosing Nicotine gum is commonly available in two strengths: 2 mg and 4 mg. Dosing is based on cigarette usage. Individuals who smoke their first cigarette within 30 minutes of waking up or smoke more than 25 cigarettes daily are recommended to use the 4 mg gum. Individuals who smoke their first cigarette at least 30 minutes after waking or smoke fewer than 25 cigarettes daily are recommended to use the 2 mg gum. Individuals who smoke fewer than 10 cigarettes daily or do not smoke every day may prefer a lower dose and to use the gum less frequently. Nicotine gum is not a direct replacement for cigarettes, but rather aims to reduce the nicotine level in the blood gradually over a period of twelve weeks. Both 2 mg and 4 mg strengths follow the same dosing schedule: Because acidic foods and beverages such as soda, coffee, and beer interfere with the absorption of nicotine by the oral mucosa, eating or drinking 15 minutes prior to or during chewing gum use is discouraged. For strong or frequent cravings, a second piece of gum may be used within an hour of finishing the previous piece. However, continuous back-to-back usage is discouraged to minimize the risk of side effects. In the initial six weeks, a minimum of 9 pieces and a maximum of 24 pieces of gum are recommended daily. It is recommended to complete the full twelve-week regimen. Side effects Side effects of nicotine gum usually arise from vigorous chewing, which releases excess nicotine. Chewing nicotine gum may cause jaw soreness. Oral mucosal irritation or ulcers can occur if the gum is repeatedly “parked” in the same location in the mouth. Similarly, excess nicotine swallowed with saliva may cause sore throat due to esophageal irritation, or gastrointestinal symptoms such as abdominal pain, nausea, and vomiting. It can