Pharmacologic Treatments for Quitting Smoking: Nicotine Replacement Therapies and Non-Nicotine Containing Medications
Nicotine replacement therapy
Prior to using any smoking cessation product that contains nicotine, it is very important to stop smoking and as well as stop using any other nicotine-containing products. Carefully read the labels of these medicines for directions on product use and other pertinent information. Consult with your physician or pharmacist before using any over-the-counter nicotine replacement therapy to make sure these treatments are compatible with your current medications and medical conditions. Store all medications out of the reach of children and pets. A brief summary of smoking cessation products is provided below.
Nicotine gum and lozenges
Nicorette® gum and Commit® lozenges are available without a prescription in 2- and 4-mg doses. The dose for nicotine gum is based on how much the patient smokes per day. Patients who smoked 25 or more cigarettes per day should use the 4-mg gum; those who smoked fewer than 25 cigarettes per day should use the 2-mg gum. The product information should be consulted for specific dosage guidelines. The gum should be chewed slowly until a peppery taste or slight tingling occurs, then it should be parked between the cheek and gum until this sensation is gone; this process should be repeated until most of the tingling subsides.
Eating or drinking (except water) should be avoided 15 minutes before or after using the gum or lozenges. Acidic beverages can reduce the absorption of nicotine and should not be consumed while chewing the gum.
Some possible adverse effects caused by nicotine gum include injury to mouth, teeth or dental work, jaw fatigue, soreness, upset stomach, gas, heartburn, nausea, increased salivation, and hiccups. Nicotine gum can be difficult to use if the patient has dentures.
The dose for nicotine lozenges is dependent on when the first cigarette of the day was smoked. Patients who smoked their first cigarette within 30 minutes upon waking should use the 4-mg lozenges; those who smoked at a point after 30 minutes upon waking should use the 2-mg lozenges. The product information should be consulted for specific dosage guidelines. The nicotine lozenges should not be chewed, broken, or swallowed. During administration, the lozenges should be occasionally shifted from one side of the mouth to the other; a warm tingling sensation may occur as the nicotine makes contact with the mouth tissues. It usually takes about 20 to 30 minutes for the lozenge to dissolve completely. Continuous use of the lozenges (consuming one lozenge after another) can increase side effects that include hiccups, heartburn, and nausea. It is recommended to use the gum or the lozenges for no longer than 12 weeks.
Transdermal nicotine patches
Nicotine patches are available without a prescription. Nicoderm® CQ and generic nicotine patches come in 21-, 14- and 7-mg strengths while Nicotrol® patches are available as 15-, 10-, and 5-mg patches. The recommended dosing of these products is based on the patient's prior cigarette use; the user's guide for each product should be consulted for specific dosage information. Nicoderm® CQ and generic nicotine patches should be worn for 16 to 24 hours (24 hours for patients who crave a cigarette upon waking in the morning). Nicotrol® patches should be worn for 16 hours (removed at bedtime). Do not wear more than one patch at a time and do not cut the patches in half. Apply the patch to a clean, dry, intact area of skin on the chest, back, belly, or upper arm.
Common side effects that may occur include redness, itching, and burning around the application site. Rotate the application site to reduce the occurrence of skin irritation. Since the nicotine patch contains aluminum, it needs to be removed prior to magnetic resonance imaging (MRI). The duration of therapy varies between 8 to 10 weeks depending on the patient's prior cigarette use.
Nicotine nasal spray
Nicotrol® NS is available by prescription only and is supplied as 10 ml bottles containing 10 mg/ml of nicotine with a metered spray pump. Carefully follow the directions for use. The dose of Nicotrol® NS should be individualized based on the patient's nicotine dependence. The initial recommended dose is 1 to 2 doses/hour (one dose equals two sprays, one in each nostril); do not exceed 5 doses (10 sprays) per hour. For best results use at least 8 doses per day. Do not use more than 5 doses per hour or 40 doses per day. The dosage of this medication may need to be gradually decreased prior to discontinuation.
Possible side effects include nasal irritation, upset stomach, chest tightness, headache, back pain, shortness of breath, nausea, coughing, runny nose, sneezing, throat irritation, and watery eyes. It is not recommended for use in patients with reactive airway disease (e.g., asthma) and should be used with caution in patients with chronic nasal disorders (e.g., rhinitis or sinusitis). The maximum recommended duration of treatment is 12 weeks.
Nicotrol® inhaler is available only by prescription as cartridges each containing 10 mg of nicotine. The nicotine released from the inhaler is absorbed in the mouth. Use of this inhaler mimics the hand-to-mouth routine of cigarette smoking. Carefully follow the directions for use. Patients should be allowed to self-titrate dosages based on severity of withdrawal symptoms but should use at least six cartridges per day for the initial 3 to 6 weeks of therapy. Do not use more than 16 cartridges per day. The dose should be gradually reduced throughout the treatment period.
Nicotrol® inhaler can cause mild irritation of the mouth or throat coughing, runny nose, shortness of breath and upset stomach. The recommended duration of treatment is 12 weeks; afterwards in most cases its dosage should be gradually reduced for up to an additional 12 weeks prior to discontinuation.
Non-nicotine containing medications
Bupropion (Zyban®) is a non-nicotine prescription drug approved for smoking cessation. It is available as a 150 mg tablet. It usually takes 2 weeks for Zyban® to be effective; therefore the patient should plan to stop smoking within 2 weeks after Zyban® is initiated. The initial recommended dose of Zyban® is 150-mg every morning for 3 days afterwards increased to 150 mg twice daily.
Possible side effects from this product are dry mouth, constipation, insomnia, seizures, hypertension, and nervousness. Patients usually take the drug for 7 to 12 weeks.
Varenicline (Chantix®) is another non-nicotine prescription medication available as either a 0.5- or 1-mg tablet. Chantix® should be started 1 week before an established smoking stop date. The dosage schedule of Chantix® is as follows: 0.5 mg once daily days 1 to 3, 0.5 mg twice daily days 4 to 7, then 1 mg twice daily day 8 until the end of treatment. Chantix® should be taken after eating with a full glass of water to reduce upset stomach.
The most common side effect is nausea, which may dissipate over time. Other possible side effects include insomnia and headache. It is recommended that this medication be taken for 12 weeks; if smoking cessation is achieved, Chantix® should be continued for another 12 weeks to maintain abstinence. If smoking cessation has not occurred after the first 12 weeks of therapy, Chantix® should be stopped and the patient should be seen by a physician to determine reasons for treatment failure.
© Copyright 1995-2010 The Cleveland Clinic Foundation. All rights reserved.
Can't find the health information you're looking for?
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 1/19/2006...#13394