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Medications

Appropriate use of pharmacotherapy, such as nicotine replacement therapy (NRT), bupropion or varenicline, can double a person's chances of successfully quitting tobacco.

There are different medications and therapies that may help during the quitting process. Learn more.

How to use NRT products

Nicotine Replacement Therapies (NRTs)

  • With smoking, nicotine is delivered via the lungs to the brain in 7-10 seconds, offering almost instantaneous effects.
  • Among NRTs, nasal spray has the most rapid absorption, followed by the gum, lozenge, and inhaler; absorption is slowest with the transdermal formulations.
  • Because NRTs deliver nicotine more slowly and at lower levels (e.g., 30-75% of those achieved by smoking), these agents are far less likely to be associated with dependence.
  • Aim of NRT is to replace nicotine from cigarettes without other harmful components of tobacco smoke.
  • Using nicotine replacement therapies double one's likelihood of successfully quitting smoking by reducing withdrawal symptoms.
  • Careful consideration should be used when recommending NRT for persons with active or uncontrolled heart disease:
    • Patients with recent MI (within 2 weeks)
    • Patients with underlying arrhythmias or worsening angina
  • Although NRT is not absolutely contraindicated for pregnant and lactating women, it should only be prescribed when it is determined that the benefits of taking NRT outweigh the risks.
  • NRT has not been approved by the FDA for use in youth.

Nicotine Chewing Gum (Nicorette)

  • Nicotine is released from the gum and absorbed through the gum tissue to reduce cravings.
  • Most common adverse effects: gastrointestinal disturbances, dyspepsia, nausea and hiccups, occasional headache if the gum is chewed too quickly, jaw pain, and dental problems.
  • Tips for Use
    • Chew gum slowly until peppery or tingling sensation appears (~15 to 30 chews).
    • Park gum between cheek and gum.
    • Resume chewing when sensation fades.
    • Repeat chew/park steps until sensation does not reappear.
    • Park gum at different parts of the mouth.
    • No food or drink 15 minutes before or during use.

Patients who smoke their first cigarette >30 minutes after waking

2 mg

Use one piece of gum per hour if gum is the main form of NRT. Otherwise, as needed for withdrawal or cravings if adjunct therapy is used.
Should be tapered over 3 months.
Maximum 24 pieces per day

Patients who smoke their first cigarette <30 minutes after waking

4 mg

Use one piece of gum per hour if gum is the main form of NRT. Otherwise, as needed for withdrawal or cravings if adjunct therapy is used.
Should be tapered over 3 months.
Maximum 24 pieces per day

Nicotine Lozenge (Nicorette)

  • Most effective when dissolved in the mouth; avoid chewing or swallowing.
  • Most common adverse effects: gastric and throat irritation.
  • Tips for Use
    • Allow to dissolve in mouth slowly (20-30 minutes); nicotine release may cause a tingling sensation.
    • Rotate to different areas of mouth.
    • No food or drink 15 minutes before or during use

Patients who smoke their first cigarette >30 minutes after waking

2 mg

One lozenge can be used every 1–2 hours or as needed if used in combination with patch.
Maximum 20 per day
Duration 12 weeks

Patients who smoke their first cigarette within 30 minutes of waking

4 mg

One lozenge can be used every 1–2 hours or as needed if used in combination with patch.
Maximum 20 per day
Duration 12 weeks

Nicotine Patch (NicoDerm CQ)

  • The patch provides a low continuous dose of nicotine that is absorbed through the skin.
  • The patch is applied once a day and worn for 16-24 hours.
  • Duration of therapy 8 to 10 weeks.
  • Tips for use:
    • Apply one new patch every 24 hours on skin that is dry, clean and hairless.
    • Wash hands after applying or removing patch.
    • Do not cut patch and do not wear more than once patch at a time.
  • The most common adverse reaction is skin irritation.
  • If sleep disturbance occurs, apply for 16 hours and remove at night.

>10 cigarettes/day

21 mg/24 hour patch for 4-6 weeks
14 mg/24 hour patch for 2 weeks
7 mg/24 hour patch for 2 weeks

At least 8 weeks

<10 cigarettes/day

14 mg/24 hour patch for 6 weeks
7 mg/24 hour patch for 2 weeks

At least 8 weeks

Nicotine Inhaler (Nicotrol Inhaler) Prescription only and require PA for Medicaid coverage

  • Nicotine is absorbed through the throat and mouth when inhaling.
  • Recommended dose for monotherapy: 6-16 cartridges per day for the first 6 weeks.
  • Can also be used as needed in combination with nicotine patches.
  • Start tapering by 3 months.

Nicotine nasal spray (Nicotrol NS) Prescription only and require PA for Medicaid coverage

  • Can be used up to five times an hour, and no more than 40 times in a day.
  • Usual dose is two sprays, one in each nostril.
  • For monotherapy start at 1-2 doses/hour; maximum dose is 5 doses/hour or 40 doses/day.
  • Treatment for up to 8 weeks then stopping or tapering dose for 4-6 weeks.
  • Can also be used as needed in combination with nicotine patches.
  • The spray has not been widely used because many find it irritating and uncomfortable.

Non-Nicotine Oral Therapy

Bupropion SR (Wellbutrin, Zyban)

  • Exact mechanism is unknown; it is thought to work by enhancing dopamine levels.
  • Helps to reduce withdrawal symptoms.
  • Should be started one to two weeks before one's quit date.
  • Recommended dose: 150 mg once per day for 3 days, increasing to 150 mg twice per day for 12 weeks.
  • Can be combined with NRT to help improve success rates
  • Main adverse effects: insomnia, headache, dry mouth, nausea, dizziness, and anxiety
  • Serious adverse events: rare incidences of seizures
  • Bupropion is contraindicated in the following patients:
    • Allergy to bupropion
    • Current use of bupropion (Wellbutrin) therapy
    • Past or current seizures
    • Known central nervous system tumors
    • Patients undergoing abrupt withdrawal from alcohol or benzodiazepines
    • Current or previous history of bulimia or anorexia nervosa
    • Use of monoamine oxidase inhibitors within the past 14 days
  • Monitor for neuropsychiatric symptoms (changes in behavior, agitation, depressed mood, and suicidal ideation).
  • Use caution with renal and liver failure.

Varenicline (Chantix)

  • Chantix prevents nicotine from stimulating the brain and reduces the pleasure received when smoking, helping to reduce cravings and withdrawal symptoms.
  • Take one week before quit date.
    • Take one white tablet daily (0.5mg) for 3 days
    • Then one white tablet (0.5 mg) twice daily for 4 days
    • Then one blue tablet (1mg) twice daily for up to 12 weeks
  • Not to be combined with Nicotine Replacement Therapies (NRTs)
  • Monitor for neuropsychiatric symptoms (changes in behavior, agitation, depressed mood, and suicidal ideation).
  • Other adverse effects include nausea, abnormal/vivid dreams, and insomnia.
  • Use caution with renal failure.
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