Nicotine Replacement

1. See Also
   1. Tobacco abuse
2. Indications
   1. Tobacco Cessation
3. Preparations
   1. Nicotine Patch (e.g. Nicoderm, Nicotrol, Habitrol)
      1. Best in white, non-obese with low nicotine dependence
      2. Lerman (2004) Ann Intern Med 140:426-33
   2. Nicotine Gum (Nicorette)
      1. Delays weight gain compared with other options
      2. May be preferred in cessation of chewing Tobacco
      3. Consider using in combination with the patch
   3. Nicotine Nasal Spray
      1. Best in obese heavy smokers and non-white patients
      2. Lerman (2004) Ann Intern Med 140:426-33
   4. Nicotine Inhaler (Nicotrol Inhaler)
4. Management: Adjunctive medications
   1. Bupropion
      1. Significantly increases Tobacco Cessation efficacy
      2. See Tobacco Cessation
   2. Varenicline (Chantix)
      1. Not recommended due to increased cardiovascular risk
   3. Mecamylamine (Inversine)
      1. Increases abstinence rates with Nicotine Replacement
      2. Rose (1994) Clin Pharmacol Ther 56:86-99
5. Precautions
   1. Avoid Electronic Cigarette (E-Cigarette)
      1. Inadequate safety available for these devices and the inhaled vapor compared other Nicotine Replacement forms
   2. Avoid Hookah Pipe (Tobacco smoke drawn through water before inhalation)
      1. Water does not filter Tobacco-related toxins
      2. Hookah users tend to smoke for longer and have greater exposure
   3. References
      1. (2013) Presc Lett 20(5): 27
      2. Vardavas (2012) Chest 141(6):1400-6
      3. Trtchounian (2011) Tob Control 20:47-52