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Nicotine Replacement
Aka: Nicotine Replacement
- See Also
- Tobacco Abuse
- Indications
- Tobacco Cessation
- Approach
- Eight week course is sufficient with little added benefit to longer use
- Schnoll (2015) JAMA Intern Med 175(4): 504-11 [PubMed]
- Nicotine Replacement may be used in combination
- Controller medication (long-acting): Nicotine Patch
- Rescue medication (short acting): Nicotin Gum, Nicotine Lozenge, Nicotine Inhaler
- Tobacco and Nicotine Replacement overlap
- Best to quit simultaneously with starting Nicotine Replacement
- However, now considered safe (although not ideal) to taper Tobacco use while initiating Nicotine Replacement
- Simultaneous use was considered a risk for coronary events
- Now appears that smokers will self titrate their nicotine levels
- When Tobacco is still being used, Nicotine Replacement is reduced to maintain a constant nicotine level
- Preparations: Long acting
- Nicotine Patch (e.g. Nicoderm, Nicotrol, Habitrol)
- Best in white, non-obese with low nicotine dependence
- Lerman (2004) Ann Intern Med 140:426-33 [PubMed]
- Preparations: Short-acting
- Nicotine Gum (Nicorette)
- Delays weight gain compared with other options
- May be preferred in cessation of chewing Tobacco
- Consider using in combination with the patch
- Nicotine Nasal Spray (Intranasal Nicotine)
- Best in obese heavy smokers and non-white patients
- Lerman (2004) Ann Intern Med 140:426-33 [PubMed]
- Nicotine Inhaler (Nicotrol Inhaler)
- Nicotine Lozenge
- Management: Adjunctive medications
- Bupropion
- Significantly increases Tobacco Cessation efficacy
- See Tobacco Cessation
- Varenicline (Chantix)
- Not recommended due to increased cardiovascular risk
- Mecamylamine (Inversine)
- Increases abstinence rates with Nicotine Replacement
- Rose (1994) Clin Pharmacol Ther 56:86-99 [PubMed]
- Precautions
- Avoid Electronic Cigarette (E-Cigarette)
- Inadequate safety available for these devices and the inhaled vapor
- Other standard Nicotine Replacement forms are well studied and regulated
- Avoid Hookah Pipe (Tobacco smoke drawn through water before inhalation)
- Water does not filter Tobacco-related toxins
- Hookah users tend to smoke for longer and have greater exposure
- References
- (2013) Presc Lett 20(5): 27
- Vardavas (2012) Chest 141(6):1400-6 [PubMed]
- Trtchounian (2011) Tob Control 20:47-52 [PubMed]
- Resources
- FDA consumer update on Nicotine Replacement
- http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm345087.htm
- References
- Wynn (2012) J Pharm Pract 25(6):591-9