SMOKING CESSATION THERAPIES | |||||
---|---|---|---|---|---|
Smoking cessation pharmacotherapy should be Patients must stop smoking before starting a Pregnant or breastfeeding smokers should first be Continue Reading Pediatric and adolescent patients should be Local skin reactions may occur with nicotine Strict dieting and other strong measures should not |
|||||
Generic | Brand | Strength | Adult Dose | Notes | |
TRANSDERMAL | |||||
nicotine | Habitrol | OTC | 21mg/ day, 14mg/ day, 7mg/ day |
>10cigarettes/day: 21mg patch daily for 4wks; then 14mg patch daily for 2wks, then 7mg patch daily for 2wks, then stop ≤10cigarettes/day: 14mg patch daily for 6wks then 7mg patch daily for 2wks, then stop |
Apply to clean, dry, nonhairy site on trunk or upper outer arm. Rotate sites. Do not cut patch. Remove patch after 24hrs; if vivid dreams or other sleep disturbances occur, remove at bedtime and reapply in AM. |
Nicoderm CQ | OTC | 21mg/ 24hr, 14mg/ 24hr, 7mg/ 24hr |
>10cigarettes/day: 21mg patch daily for 6wks; then 14mg patch daily for 2wks; then 7mg patch daily for 2wks; then stop ≤10cigarettes/day: 14mg patch daily for 6wks; then 7mg patch daily for 2wks; then stop |
Apply to clean, dry, nonhairy site on trunk or upper outer arm. Rotate sites. Remove after 16−24hrs; if vivid dreams or other sleep disturbances occur, remove at bedtime and reapply in AM. | |
CHEWING GUM | |||||
nicotine polacrilex | Nicorette | OTC | 2mg, 4mg | Use 1 piece every 1−2hrs for 6wks (at least 9 pieces/day), then every 2−4hrs for 3wks, then every 4−8hrs for 3wks, then stop; max 24 pieces/day. If strong or frequent cravings, may use 2nd piece within the hour; avoid continuous use. | Use 2mg if patient smoked 1st cigarette >30mins after waking up; use 4mg if patient smoked 1st cigarette within 30mins of waking up. Do not eat or drink for 15min before and during use. |
NASAL SPRAY | |||||
nicotine | Nicotrol NS | Rx | 0.5mg/ spray |
Individualize. Usually 1−2 doses/hr; max 5 doses/hr, 40 doses/day for up to 3mos; may discontinue abruptly or taper. | Do not sniff, swallow, or inhale spray. Nasal vasoconstrictors may delay absorption. |
INHALER | |||||
nicotine inhalation system | Nicotrol Inhaler | Rx | 10mg/ cartridge (4mg delivered) |
Individualize. Use at least 6 cartridges/day for 1st 3−6wks; max 16 cartridges/day for 1st 12wks, then reduce gradually over 12 more weeks. | Each cartridge lasts about 20min with frequent continuous puffing and provides nicotine equivalent to about 2 cigarettes. |
LOZENGES | |||||
nicotine polacrilex | Nicorette Lozenge | OTC | 2mg, 4mg | 1 lozenge every 1−2hrs (at least 9 lozenges/day) for 6wks, then every 2−4hrs for 3wks, then every 4−8hrs for 3wks, then stop; max 5 lozenges/6hrs (20 lozenges/day). | Use 2mg if patient smoked 1st cigarette >30mins after waking up; use 4mg if patient smoked 1st cigarette within 30mins of waking up. Dissolve slowly in mouth; minimize swallowing. Do not eat or drink for 15min before and during use. |
Nicorette Mini Lozenge | OTC | ||||
TABLETS | |||||
varenicline tartrate | Chantix | Rx | 0.5mg, 1mg | Initially 0.5mg once daily for 3 days, then 0.5mg twice daily for 4 days, then 1mg twice daily. Treat for 12wks; may continue 12 more weeks if patient successfully stops smoking to further increase the likelihood of abstinence. Reduce dose in renal impairment. | Begin therapy 1wk before target quit date. Alternatively, may begin therapy and then quit smoking between Days 8 and 35 of treatment. Take after eating with a glass of water. May reduce dose if intolerable nausea or other adverse effects occur. |
bupropion HCl |
Zyban | Rx | 150mg sustained-release tablets |
Initially 150mg once daily for 3 days, then 150mg twice daily at least 8hrs apart; max 300mg/day in divided doses. | Swallow whole. Set target quit date within 1−2wks after start. Treat for 7−12wks; reevaluate if no significant progress by Week 7; up to 6 mos’ therapy has been shown to be effective. Avoid bedtime dosing. |
REFERENCES | |||||
Adapted from Clinical Practice Guidelines No. 18, AHCPR Pub. #96‑0692, 4/96 and product labeling. For more information see product entries. (Rev. 3/2014) |
This article originally appeared on MPR