Medication Options and Dosages
| PATCHES | GUM | LOZENGE | ||
|---|---|---|---|---|
| Brand Strength |
Nicotrol® 15 mg |
Nicoderm®CQ® 21, 14, 7 mg |
Nocorette® 2, 4mg |
Commit™ 2, 4mg |
| Dosing | 1 patch/ 16 hours |
1 patch/ 24 hours |
1 piece/1-2 hours | 1 loz./1-2 hrs wks 1-6 1 loz./2-4 hrs wks 7-9 1 loz./4-8 hrs wks 10-12 |
| Duration | 8 weeks | 8 weeks | 8-12 weeks | 12 weeks |
| Advantages | Private; once/day | Can offset cravings, delays weight gain | Decreasing amounts reduce dependence | |
| Adverse Reactions | 50% experience local skin reaction (rotate and use steriod cream); sleep disturbances (remove at bedtime) | Mouth soreness, hiccups, dyspepsia | Indigestion, insomnia, hiccups, mouth soreness | |
| Contraindications | Severe eczema or other skin diseases or allergies that may be exacerbated by the patch | TMJ or other jaw problems; dentures | TMJ; mouth or tongue problems | |
| Telephone | 1-800-699-5765 | 1-800-834-5895 | 1-888-569-1743 | 1-800-419-4766 |
| Web Address | nicotrol.com | nicodermCQ.com | nicorette.com | commitlozenge.com |
| SPRAY | INHALER | TABLETS | ||
|---|---|---|---|---|
| Brand Strength |
NicotrolNS® 10 mg/ml |
Nicotrol® 10 mg/cartridge |
Zyban® 150mg |
Chantix® .5, 1mg |
| Dosing | 2-10 sprays/hour | 6-16 cartridges/day | 150 mg/day (days 1-3) 300 mg/day (day 4+) |
.5 mg/(days 1-3) .5 mg 2x/day (days 4-7) 1 mg 2x/day (days 8-28+) |
| Duration | 3-6 months | 3-6 months | 7-12 weeks | 12-24 weeks |
| Advantages | Responds quickly to cravings (6 min) | Keeps hands busy, mimics smoking | Also treats depression, delays weight gain | Blocks brain’s nicotine receptors, studies show higher success rates than other medications |
| Adverse Reactions | Transient nasal irritation, sore throat, watery eyes | 40% experience mouth and throat irritation, dyspepsia | Dry mouth, insomia, shakiness | Nausea, sleep disturbance, constipation, flatulence, vomiting |
| Contraindications | Asthma, rhinitis, nasal polyps, sinusitis | Allergy to menthol | Seizure disorder; bupropion allergy; bulimia or anorexia nervosa; concurrent use of MAO inhibitors | Under age 18; pregnant/nursing; dosage adjustment recommended for elderly and those with severe renal impairment or undergoing hemodialysis |
| Telephone | 1-800-699-5765 | 1-800-699-5765 | 1-800-U-CAN-QUIT | 1-877-CHANTIX |
| Web Address | nicotrol.com | nicotrol.com | zyban.com | chantix.com |
This adult options and dosages chart is provided strictly for the convenience of the prescribing clinician. Please consult the Physician’s Desk Reference for complete product information and contraindications.
Clinical Notes
Pharmacotherapies for the treatment of nicotine dependence are known to
- Double long-term quit rates and
- Help ALL patients who use tobacco, are interested in quitting and do not have a medical contraindication to NRT (Nicotine Replacement Therapy) or bupropion SR (Zyban®) or Chantix.
Children and Adolescents
Recommend NRT only when there is clear evidence of nicotine dependence and a desire to quit. Consider body weight and degree of dependence when selecting NRT dose.
Pregnant Women
In the absence of adequate studies on the safety of pharmacotherapy in pregnant women, encourage pregnant smokers to quit using behavioral interventions first. Recommend pharmacotherapy if the likelihood of smoking abstinence, with its potential benefits, clearly outweighs the risk of pharmacotherapy.
Light Smokers
Consider reducing the dose of NRT for those who smoke fewer than 12 cigarettes per day. No adjustments are necessary when using bupropion SR.
Psychiatric Conditions
Bupropion SR abates mood-related withdrawal symptoms and produces few adverse effects. Combined with NRT, bupropion SR helps decrease the relapse to smoking common among smokers with psychiatric conditions, such as depression and alcohol abuse.
Cardiovascular Disease
NRT, particularly the patch, presents no adverse cardiovascular effects. Nevertheless, weigh the risks and benefits among patients in the first four weeks of post-myocardial infarction and those with serious arrhythmias or severe angina pectoris.
Peptic Ulcer Disease
Although no studies are available on NRT’s effects on ulcer disease, nicotine may delay healing of active ulcers. Weigh risks and benefits of NRT in patients with active ulcer.
Other Conditions That May Contraindicate NRT
- Severe renal failure
- Active hyperthyroidism
- Poorly controlled insulin-dependent diabetes
- Severely uncontrolled hypertension
- Peripheral vascular disease
Long-term Use of Pharmacotherapies
The long-term use of NRT or bupropion SR presents no known health risks. Recommend long-term therapy (six or more months) for smokers reporting persistent withdrawal symptoms. Encourage patients who stop medication prematurely to continue use for the recommended duration.
Combining Pharmacotherapies
Recommend combination therapy for patients who have failed on monotherapy or who are heavily addicted. Quit rates have been shown to increase slightly by combining the nicotine patch with other NRTs or bupropion SR.
