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| Nicotine replacement therapy (NRT) formulations |
Precautions | Dosing by daily smoking level | Treatment duration | Adverse effects | Advantages | Disadvantages | Daily cost, $1 |
|---|---|---|---|---|---|---|---|
| Gum Nicorette2, 2 mg, 4 mg (regular, mint, orange) Generic3, 2 mg, 4 mg |
Pregnancy; recent (<2 wk) myocardial infarction; serious underlying arrhythmias; serious or worsening angina pectoris; temporomandibular joint disease |
(25 cigarettes: 2 mg >=25 cigarettes: 4 mgWeek 1-6: 1 piece q 1-2 hr Week 7-9: 1 piece q 2-4 hr Week 10-12: 1 piece q 4-8 hr4 |
Up to 12 wk | Mouth or jaw soreness; hiccups; dyspepsia; hypersalivation; associated with incorrect chewing technique: lightheadedness, nausea or vomiting, throat and mouth irritation |
May satisfy oral cravings; may delay weight gain; patient can titrate therapy to manage withdrawal symptoms |
Social acceptance of gum; difficult to use with dentures; must use proper chewing technique to minimize adverse effects |
2 mg (9 pieces): 3.33 -5.16 4 mg (9 pieces): 3.78 -5.81 |
| Transdermal preparations Nicotrol patch5, 15 mg (16 hr) |
Pregnancy; recent (<2 wk) myocardial infarction; serious underlying arrhythmias; serious or worsening angina pectoris; patients with dermatologic conditions (eg, psoriasis, eczema, atopic dermatitis) |
>=10 cigarettes: 15 mg/d for 6 wk <10 cigarettes: not recommended |
6 wk | Local skin reactions (erythema, pruritus, burning); headache |
One-step process; easy to use and conceal; fewer compliance issues |
Patient cannot titrate doses; 16-hr release may lead to early morning (on waking) cravings; allergic reactions to adhesive may occur |
3.68 |
| Nicoderm CQ2, 21 mg, 14 mg, 7 mg (24 hr) |
Same as for other transdermal systems |
>10 cigarettes: 21 mg/d for 6 wk; 14 mg/d for 2 wk; 7 mg/d for 2 wk <=10 cigarettes: 14 mg/d for 6 wk; 7 mg/d for 2 wk |
8-10 wk | Local skin reactions (erythema, pruritus, burning); headache; sleep disturbances (insomnia) or abnormal or vivid dreams (associated with nocturnal nicotine absorption) |
Provides 24-hr steady-state levels, which may reduce morning cravings; easy to use and conceal; fewer compliance issues |
Patient cannot titrate doses; allergic reactions to adhesive may occur |
3.39 |
| Generic patch6 7, 21 mg, 14 mg, 7 mg (24 hr) |
Same as for other transdermal systems |
>=10 cigarettes: 21 mg/d for 4 wk; 14 mg/d for 2 wk; 7 mg/d for 2 wk <10 cigarettes: 14 mg/d for 6 wk; 7 mg/d for 2 wk |
8 wk | Same as for Nicoderm CQ | Same as for Nicoderm CQ |
Same as for Nicoderm CQ |
2.53-2.70 |
| Generic patch8, 22 mg, 11 mg (24 hr) |
Same as for other transdermal systems |
>15 cigarettes: 22 mg/d for 6 wk <=15 cigarettes: 11 mg/d for 6 wk |
6 wk | Same as for Nicoderm CQ | Same as for Nicoderm CQ and one-step proccess |
Same as for Nicoderm CQ |
3.11-3.50 |
| Nasal spray Nicotrol9 metered spray (0.5 mg nicotine in 50-µL aqueous nicotine solution) |
Pregnancy; recent (<2 wk) myocardial infarction; serious underlying arrhythmias; serious or worsening angina pectoris; underlying chronic nasal disorders (rhinitis, nasal polyps, sinusitis); severe reactive airway disease |
1-2 doses/hr (8-40 doses/d); 1 dose = 2 sprays (1 in each nostril); each spray delivers 0.5 mg of nicotine to the nasal mucosa |
3-6 mo | Nasal and/or throat irritation; rhinitis ; tearing; sneezing; cough; headache |
Patient can titrate therapy to rapidly manage withdrawal symptoms |
Initial nasal or throat irritation may be bothersome; dependence; wait 5 min before driving or operating heavy machinery (may cause tearing or sneezing); avoid contact with skin (absorbed topically) |
3.40 for 8 doses |
| Oral inhaler Nicotrol inhaler9, 10-mg cartridge delivers 4 mg inhaled nicotine vapor |
Pregnancy; recent (<2 wk) myocardial infarction; serious underlying arrhythmias; serious or worsening angina pectoris; underlying reactive airway disease |
6-16 cartridges/d; individualized dosing | Up to 6 mo | Mouth and/or throat irritation; unpleasant taste; cough; rhinitis; dyspepsia; hiccups; headache |
Mimics hand-to-mouth ritual of smoking; patient can titrate therapy to manage withdrawal symptoms |
Initial throat or mouth irritation may be bothersome; cartridges should not be stored at temperatures <30°C (>86°F) or <15°C (<59°F) |
6.07 for 6 cartridges |
| Bupropion hydrochloride SR Zyban10 sustained-release tablet |
Pregnancy; concomitant therapy with medications known to lower the seizure threshold Contraindications: history of seizure disorder; history of bulimia or anorexia nervosa; MAO inhibitor therapy in the previous 14 days; concomitant therapy with other bupropion products11 |
150 mg orally each morning for 3 days, then increase to 150 mg orally twice a day |
7-12 wk after quit date12 | Insomnia; dry mouth; nervousness or difficulty concentrating; rash; constipation; seizures risk 1/1,000 (0.1%) |
Ease of use; can be safely used in combination with NRT; may be beneficial in patients with coexisting depression |
Seizure risk (rare); do not use in patients taking medications that can lower the seizure threshold |
3.37 |
q = every;
MAO = monoamine oxidase.
1Average wholesale price,
2001 Drug Topics Redbook. Montvale, NJ: Medical Economics Company, Inc;
2001 Dec.
2Nonprescription product distributed by
GlaxoSmithKline; web page for gum: http://www.nicorette.com/; web page for
patch: http://www.nicodermcq.com/. Note
that trade names are given for information purposes only and are not to be
construed as endorsement by either the editors of this journal or the authors.
3Nonprescription product distributed by Watson
Laboratories.
4Not to exceed 24 pieces a day.
5Nonprescription product distributed by Pharmacia
Corporation; web page: http://www.nicotrol.com/.
6Nonprescription product (formerly Habitrol) distributed by
Novartis Consumer Health; web page: http://www.habitrol.com/.
7Prescription product distributed by Schein Pharmaceuticals.
8Nonprescription product (formerly Prostep)
distributed by Perrigo Company.
9Prescription
product distributed by Pharmacia Corporation; web page: http://www.nicotrol.com/.
10Prescription product distributed by GlaxoSmithKline; web
page: http://www.zyban.com/.
11Such as Wellbutrin or Wellbutrin SR.
12In some patients, maintenance treatment for as long as 6
months may be appropriate.
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