II. Indications

III. Approach

  1. Eight week course is sufficient with little added benefit to longer use
    1. Schnoll (2015) JAMA Intern Med 175(4): 504-11 [PubMed]
  2. Nicotine Replacement may be used in combination
    1. Controller medication (long-acting): Nicotine Patch
    2. Rescue medication (short acting): Nicotin Gum, Nicotine Lozenge, Nicotine Inhaler
  3. Tobacco and Nicotine Replacement overlap
    1. Best to quit simultaneously with starting Nicotine Replacement
    2. However, now considered safe (although not ideal) to taper Tobacco use while initiating Nicotine Replacement
    3. Simultaneous use was considered a risk for coronary events
      1. Now appears that smokers will self titrate their nicotine levels
      2. When Tobacco is still being used, Nicotine Replacement is reduced to maintain a constant nicotine level

IV. Preparations: Long acting

  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 [PubMed]

V. Preparations: Short-acting

  1. 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
  2. Nicotine Nasal Spray (Intranasal Nicotine)
    1. Best in obese heavy smokers and non-white patients
    2. Lerman (2004) Ann Intern Med 140:426-33 [PubMed]
  3. Nicotine Inhaler (Nicotrol Inhaler)
  4. Nicotine Lozenge

VI. Management: Adjunctive medications

  1. Bupropion
    1. Significantly increases Tobacco Cessation efficacy
    2. See Tobacco Cessation
  2. Varenicline (Chantix)
    1. See Tobacco Cessation
  3. Mecamylamine (Inversine, Vecamyl)
    1. Rarely used in U.S. for Tobacco Cessation
    2. Increases abstinence rates with Nicotine Replacement
    3. Rose (1994) Clin Pharmacol Ther 56:86-99 [PubMed]

VII. Adverse Effects

  1. Headache
  2. Nausea
  3. Vomiting
  4. Indigestion
  5. Disturbed sleep

VIII. Precautions

  1. Avoid Electronic Cigarette (E-Cigarette)
    1. Inadequate safety available for these devices and the inhaled vapor, and risk being continued indefinitely
    2. Other standard Nicotine Replacement forms are well studied and regulated
  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 [PubMed]
    3. Trtchounian (2011) Tob Control 20:47-52 [PubMed]

IX. Resources

  1. FDA consumer update on Nicotine Replacement
    1. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm345087.htm

X. References

  1. Wynn (2012) J Pharm Pract 25(6):591-9

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Ontology: Nicotine replacement therapy (C1278444)

Definition (NCI) Therapy to help control nicotine withdrawal symptoms during tobacco cessation
Definition (NCI_NCI-GLOSS) A type of treatment that uses special products to give small, steady doses of nicotine to help stop cravings and relieve symptoms that occur when a person is trying to quit smoking. These products include nicotine gum, nicotine inhaler, nicotine nasal spray, nicotine lozenges, and nicotine patch. They do not contain any of the other chemicals found in tobacco products.
Definition (CSP) nicotine complexed with polymers for the controlled release of nicotine as deterrent for the eventual cessation of abusing tobacco products.
Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 313396002, 182828001, 151159008
English Nicotine replacement therapy (context-dependent category), Nicotine replacement therapy (situation), nicotine replacement therapy, nicotine replacements, nicotine replacement, nicotine replacement therapies, Nicotine replacement therapy (procedure), Nicotine replacement therapy, NRT, Nicotine Replacement Therapy, Nicotine Replacement
Spanish terapia sustitutiva de nicotina (situación), terapia sustitutiva de nicotina (categoría dependiente del contexto), terapia de reemplazo con nicotina, terapia sustitutiva de nicotina