Layout

Comparison Of Current Pharmacotherapy For Nicotine Dependence Treatment** Rx Bupropion HCI
OTC Nicotine Patch
OTC Nicotine Gum and Lozenge
Rx Nicotine Spray
Rx Nicotine Inhaler
Varenicline
SR Tablet
BRAND NAME
PRODUCT STRENGTHS
INITIAL DOSING
1–2 doses/hour (1 dose = 2 sprays per nostril) MAX DOSING
TIME TO PEAK PLASMA LEVEL
RECOMMENDED
TREATMENT DURATION
50% experience mild skin reactions (rotate and use Mouth soreness, hiccups, dyspepsia and, for gum, Local transient irritation in the nose and throat, steroid cream); vivid dreams, sleep disturbances irritation (resolved through regular use); ADVERSE REACTIONS
jaw ache (usually mild and transient; correct technique watery eyes, sneezing and cough, runny nose while on the patch for 24 hours (remove at bed time) UNIQUE PRODUCT
CONTRAINDICATIONS
Severe eczema or other skin diseases which may be Asthma, rhinitis, nasal polyps, or sinusitis exacerbated by the patch; allergy to adhesive tape (GENERAL NRT CONTRAINDICATIONS ON OTHER SIDE)
CONSUMER INFORMATION
QuitWorks
Solution
COST/DAY
(PRICES AS OF 4/00)
Treatment Duration:
Peptic Ulcer Disease
■ Recommended duration of therapy is up to 12 wks.
■ Nicotine may delay healing of active ulcers.
There is limited evidence that combining patch and other NRTs or patch and bupropion may slightly increase quit rates over monotherapy.
■ No studies are available on the effects of NRT on ulcer disease.
May be the best choice of NRT for most patients. Adherence Combination therapy may be considered in persons who have failed is usually better than with nicotine gum, spray or inhaler.
Nicotine nasal spray is available by prescription only. It provides the ■ Weigh risks and benefits of NRT in patients with active ulcer.
on monotherapy or are heavily addicted.
Dose & Technique:
most rapid nicotine delivery of all NRT products and provides greater Other Conditions Which May Contraindicate NRT
■ Start most smokers of 10–15 cigarettes or more/day at the highest
capacity for self-titration of dose. Dependency potential is greater with ■ Severe renal failure.
Although psychiatric conditions (e.g., depression, alcohol abuse and the spray than with nicotine gum or the nicotine patch.
■ Active hyperthyroidism.
dependence) place smokers at increased risk for relapse to smoking, ■ If vivid dreams or sleep disturbances are experienced, remove
Dose & Technique:
■ Poorly controlled insulin-dependent diabetes.
smoking cessation treatments can be effective, and NRT and bupropion ■ Usual single dose is two sprays, one in each nostril.
■ Severely uncontrolled hypertension.
should be considered as part of a comprehensive approach to cessation.
■ Consider lower starting doses in smokers of less than 10 cigarettes/day.
■ Start patient at 1–2 doses/hour.
■ Peripheral vascular disease.
One of the benefits of NRT and bupropion is that they abate mood- ■ A new patch is applied each morning to the upper torso.
■ Maximum dose: 5 doses/hour or 40 doses/day.
related withdrawal symptoms but produce relatively few adverse effects.
Children & Adolescents
Treatment Duration:
Treatment Duration:
NRT should be considered in children and adolescents only when ■ Treatment of 8 wks or less has been shown to be as effective as longer
■ Recommended duration of therapy is 3–6 months.
there is clear evidence of nicotine dependence and clear desire to quit.
Dose & Technique:
Degree of dependence and body weight should be considered when ■ Maximum dose is 2.0 mg/day, given as 1.0 mg twice daily.
■ Tapering dose after 4 wks is generally recommended for most smokers.
The nicotine inhaler is available by prescription only. It addresses ■ Dosing should begin at 0.5 mg/day given every day for the first 3 days,
■ Use for longer duration if unsuccessful on shorter duration.
pharmacological, behavioral and sensory stimuli aspects of smoking.
followed by a dose increase to 0.5 mg taken morning and evening ■ Use for longer duration at higher dose for heavier smokers.
The nicotine is absorbed through the lining of the mouth.
There are no adequate studies on the safety of pharmacotherapy in for the next 4 days. On Day 8 and beyond, the recommended dose is Dose & Technique:
pregnant women. Pregnant smokers should be encouraged to quit using behavioral interventions before pharmacological approaches are used.
■ A dose consists of a puff or inhalation.
■ Treatment with varenicline should be initiated while the patient
Pharmacotherapy is recommended only if the increased likelihood of ■ Each cartridge delivers 4 mg of nicotine over 80 inhalations; only 2 mg
is still smoking; approximately one week of treatment is required ■ Have not been successful on the patch.
smoking cessation clearly outweighs the risk of pharmacotherapy.
are actually absorbed (this is the equivalent of about 2 cigarettes).
to achieve steady- state blood levels. Quit attempt should occur ■ Prefer the gum or lozenge for personal reasons
■ Advise patient not to drink acidic beverages 15 min before and during
during second week of treatment. Patients should be encouraged ■ Are interested in quitting AND
■ Have had a severe skin reaction to the patch.
to continue to attempt to quit if they have early lapses after quit day.
■ Do not have a medical contraindication
Dose & Technique:
■ Best effects are achieved by frequent puffing.
■ Do not have a history of seizures.
Treatment Duration:
■ Specify 2 mg gum for those who smoke less than 25 cigarettes/day.
■ Recommended dosage is 6–16 cartridges/day; patients may self-titrate
■ Prefer an alternative to nicotine replacement.
■ Treatment should be continued for up to 11 weeks following quit date.
Specify 4 mg gum for more highly dependent smokers (25 or more to the level of nicotine they require.
Dose & Technique:
■ Patients who are abstinent at week 12 may benefit from and additional
cigarettes/day, smoking within 30 min of awakening, and/or those ■ Maximum dose: 16 cartridges/day.
■ Maximum dose is 300 mg/day, given as 150 mg twice daily.
course of 2.0 mg b.i.d. for up to twelve weeks.
finding it difficult to refrain from smoking where it is forbidden).
Treatment Duration:
■ Dosing should begin at 150 mg/day given every day for the first 3 days,
■ Dose tapering is not required when discontinuing treatment.
■ Specify 2 mg lozenge for those whose first cigarette of the day is more
** Little research is available on the use of pharmacotherapy with patients who smoke less than
followed by a dose increase for most patients to the recommended dose 10 –15 cigarettes per day. For these light smokers a lower starting dose of the nicotine patch than 30 min after awakening. Specify 4 mg lozenge for those who ■ Recommended duration of therapy is up to 6 months.
of 300 mg/day. Interval of at least 8 hours between successive doses.
or gum could be considered. No adjustments are necessary when using bupropion SR.
smoke within 30 min after awakening.
■ Instruct patient to taper dosage during last 6–12 wks of treatment.
Varenicline should not be used in combination with NRT due to ■ Treatment with bupropion should be initiated while the patient
** Inclusion of this adult dosage chart is strictly for the convenience of the prescribing provider.
■ Recommend patient use one piece of gum or one lozenge every
Please consult the Physicians’ Desk Reference for complete product information and con- Precautions & Contraindication for all NRT Products is still smoking; approximately one week of treatment is required 1–2 hrs (many patients use less than is needed for optimum effect).
traindications. This chart does not indicate or authorize insurance benefit coverage for any of (See table on back for unique product contraindications and bupropion to achieve steady- state blood levels. “Quit attempt should occur these medications. For insurance benefit information, the patient will need to contact his/her ■ Maximum dose: 24 pieces/day of either the 2 mg or 4 mg gum or
Serious neuropsychiatric symptoms have occurred in patients being insurer directly. The cost or provision of these medications is not included as any part of the 20 lozenges/day of either the 2 mg or 4 mg lozenge.
Try-To-STOP TOBACCO Resource Center of Rhode Island or QuitWorks program.
Cardiovascular Disease
treated with CHANTIX. Some cases may have been complicated by Bupropion SR can be used in combination with NRT.
■ Proper use is critical to effectiveness. For gum, emphasize the
Although not an independent risk factor for acute myocardial events, the symptoms of nicotine withdrawal in patients who stopped smoking; Treatment Duration:
importance of alternating chewing and parking each piece for 30 min.
NRT should be used only after consideration of risks and benefits among however, some of these symptoms have occurred in patients who con- The Public Health Service issued an updated clinical practice guideline, “Treating Tobacco Use and For lozenge, patient should allow it to dissolve slowly, occasionally ■ Treatment should be continued for 7–12 weeks following quit date.
particular cardiovascular patient groups including: tinued to smoke. All patients being treated with CHANTIX should be Dependence,” in June 2000. This brochure summarizes the PHS recommendations and provides moving it from one side of the mouth to another.
■ Patients who have not made significant progress towards abstinence
information on the appropriate use of nicotine replacement therapy (NRT) and bupropion SR (Zyban®).
■ Those in immediate (within 4 weeks) postmyocardial infarction period.
observed for neuropsychiatric symptoms including changes in behavior, QuitWorks was developed by the Massachusetts Department of Public Health (MDPH) in collabora- ■ Advise patient not to consume acidic beverages or food 15 min before
by the seventh week of therapy are unlikely to successfully quit during agitation, depressed mood, suicidal ideation and suicidal behavior.
■ Those with serious arrhythmias.
tion with Massachusetts health plans and has been in operation since 2002. The program has been this attempt and treatment should be discontinued.
adopted by the Rhode Island Department of Health with permission of the Massachusetts Department ■ Those with severe or worsening angina pectoris.
Precautions & Contraindication for all NRT Products ■ For maintenance therapy, consider 150 mg b.i.d. for up to 6 months.
of Public Health. The Pharmacotherapy Guide was developed by the Center for Tobacco Prevention and (See table on back for unique product contraindications and bupropion Control, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School.
■ Dose tapering is not required when discontinuing treatment.

Source: http://quitworksri.org/files/2013/05/PharmoGuide.pdf