| Products | Dosage | Indications | Considerations |
|---|
Nicotine Polacrilex:
(nicotine gum)
Nicorette® |
2 mg, 4 mg
Frequency: 9–12 pieces/day
Maximum Recommended Duration: 8–12 weeks |
Faster delivery of nicotine than patches Useful during acute episodes of craving |
Chew-and-park method1 of administration is essential Cannot eat or drink acidic beverages before, during and after gum is used |
Nicotine patch:
NicoDerm CQ®
Nicotrol®
Habitrol®
ProStep® |
21 mg, 14 mg, 7 mg*
15 mg, 10 mg, 5 mg**
21 mg, 14 mg, 7 mg***
22 mg, 11mg****
Frequency:
*24 hrs/day
**16 hrs/day
***24 hrs/day
****24 hrs/day
Maximum Recommended Duration:
*10 weeks
**6 weeks
***10 weeks
****4–12 weeks |
Very effective primary base agent Must be smoke-free while using patch, as smoking encourages relapse |
Observe for mild rashes and irritation If abnormal dreams occur, remove qhs or use 16 hr/day patch Use with caution in patients
with MI within 4 weeks Certain forms are OTC |
Nicotine nasal inhaler:
Nicotrol NS® |
0.5 mg/inhalation/nostril
Frequency:
1–2x/hr or prn
Maximum Recommended Duration: 12 weeks |
Fast delivery of nicotine Decreased craving within minutes |
Must be taught to spray rather than sniff Observe for nose, eye, upper respiratory irritation |
Nicotine oral inhaler:
Nicotrol Inhaler® |
.10 mg/cartridge
Frequency:
80 puffs over 20–30 minutes, 6x/day for a minimum of the first 3–6 weeks
Maximum Recommended Duration: 12 weeks |
May be used as adjunct therapy Mimics hand-to-mouth behavior |
May cause mouth or throat irritation Deep inhalation is not
indicated Nicotine delivery is difficult in cold, ambient conditions |
Bupropion HCl:
ZYBAN® |
150 mg qd for the first 3 days
then
150 mg b.i.d.
Maximum Recommended Duration:
7–12 weeks |
Very effective as primary agent |
Should initiate 1 week prior to quit date May be used with NRT Contraindicated in patients
with hx of seizures or eating disorders |
| 1Chew-and-park method: Instruct the patient to bite the gum slowly and deliberately. At about the 15th bite the patient will start to notice a peppery taste and a slight tingling, which means that the gum is beginning to release nicotine. Instruct the patient to park the gum between his/her cheek and gum and leave it there. When the peppery taste and the tingle fade (in about 1 minute), the patient should bite a few more times until the gum starts working again. Then the patient should park it in another part of the mouth. The patient should continue on in this manner for 30 minutes, biting and parking, until the taste and tingle stop. Then instruct the patient to throw the used gum away in a place where children and pets cannot find it. |
