Cessation Medicine Reference Guide Table of Contents

Transcription

1 Cessation Medicine Reference Guide Table of Contents 1. Patch 2. Nicotine Gum 3. Nicotine Lozenge 4. Inhaler 5. Nasal Spray 6. Bupropion SR (Zyban) 7. Chantix (Varenicline)

2 Patch Typical course of therapy is 8 weeks. 0-4 CPD: 7mg x 4wks 5-10 CPD: 14mg x 4wks; 7mg x 4wks 11+ CPD: 21mg x 4wks; 14mg x 2wks; 7mg x 2wks Apply new patch each day directly to skin; upper arm, shoulder or chest. Hold firmly in place for seconds. Remove previous day s patch. Prts who want to use longer than 12 weeks should inform their doctor of their intent. Talk to doctor or pharmacist about the use of hydrocortisone cream if local skin irritation occurs. Habitrol (21/14/7mg) Nicoderm CQ (21/14/7mg) Nicotrol (5/10/15mg) Habitrol... Yes Nicoderm CQ... Yes Nicotrol... Yes Patch s stated nicotine strength is delivered in one day s use. Peak nicotine blood levels in 3-4 hours. tant delivery of nicotine requires application only once per day Does not allow use to increase dosage as needed per situation or urge Side Effects: May cause skin irritation for some About $3 / day Pg.1

3 Nicotine Gum Typical course of therapy is 8 weeks. Up to 24 pieces per day. Use at scheduled one hour intervals. May be used as needed (prn). May be combined with patch to augment nicotine replacement. Chew 5-10 times until peppery taste & park between cheek and gum. Not to be chewed as regular gum. Discard after 20-30min. Avoid acidic beverages during use and 15min before use. Prts who want to use longer than 12 weeks should inform their doctor of their intent Nicorette (2 & 4mg) Generic Brands: (2 & 4mg) *Comes in regular, mint, and orange flavors. Nicorette (2 & 4mg)... Yes Generic Brands: (2 & 4mg)... Yes 2mg strength yields 1mg of nicotine. 4mg strength yields 2mg of nicotine min absorption rate. User can adjust the number of pieces used per day to address urge severity May be added to patch use to better manage urges to use tobacco Not all can use it (dental/jaw pain) Tendency to use less Ngum than is optimal Side Effects: May cause nausea if chewed incorrectly; May not provide enough nicotine if chewed incorrectly. About $4-$6 per day (depending on how many pieces are used per day) Pg.2

4 Nicotine Lozenge Weeks 1-4: Use 1 lozenge every 1-2hrs (at least 9 per day) Weeks 5-6: Use 1 lozenge every 2-4hrs Weeks 7-8: Use 1 lozenge every 4-8hrs Do not use more than 20 lozenges per day. Use at scheduled intervals. May be used as needed (prn). May be combined with patch to augment nicotine replacement. Slowly dissolve in mouth by moving lozenge around from time to time. Do not chew. Do not use more than one lozenge at a time. Avoid acidic beverages during use and 15min before. Prts who want to use longer than 12 weeks should inform their doctor of their intent. Do not smoke or use tobacco. Committ (2 & 4mg) *Comes in regular, mint flavors. Committ (2 & 4mg)... Yes 2mg strength yields 1mg of nicotine. 4mg strength yields 2mg of nicotine min absorption rate Lozenge results in slightly higher nicotine blood levels than Ngum. User can adjust number of pieces used per day to address urge severity. May be added to patch use to better manage urges to use tobacco Side Effects: Mouth irritation, sore throat, gas/indigestion About $5-$12 per day (depending on how many lozenges are used per day) Pg.3

5 Inhaler (Cigarette-like device with a mouthpiece and cartridge) Typical course of therapy is 12 weeks. Initial Dose: Refer prt to doctor for specific dosage and use instructions Insert cartridge into holder. Puff as with a cigarette but do not inhale into lungs. Avoid acidic beverages during use and 15min before. Refer prt to doctor or pharmacist to discuss dosage or side effects. Nicotrol Nicotrol... No (Rx) Each cartridge has about 10mg of nicotine. About 4mg is delivered per cartridge. Absorbed in mouth, not in lungs 15-20min absorption rate User can adjust dosage to address urge severity May be added to patch use to better manage urges to use tobacco May inhibit behavioral coping skills. Side Effects: May cause sore throat; some feel awkward about using in public About $6-$16 per day (depends on how many cartridges are used per day) Pg.4

6 Nasal Spray (Nasal spray similar to a decongestant) Typical course of therapy is 12 weeks. Refer prt to doctor for specific dosage and use instructions Insert tip of nozzle well into nostril. Press quickly to deliver spray. Repeat procedure with other nostril. Refer prt to doctor or pharmacist to discuss dosage or side effects. Nicotrol NS Nicotrol NS... No (Rx) Each bottle has about 200 sprays or about 100 doses of 1mg each. Absorption rate is fastest of all nicotine replacement products (typically within 5min). Provides fastest delivery of nicotine of all NRT products. User can adjust dosage to address urge severity May be added to patch use to better manage urges to use tobacco May inhibit behavioral coping skills. Burning sensation may inhibit optimal use. Side Effects: May cause sore throat for some. Some may feel awkward about using in public. About $50 per 10ml bottle, which contains about 200 sprays (or 100 doses of 1mg each) Pg.5

7 Bupropion SR Zyban (A pill that does not contain nicotine) Recommended course of therapy is 8 12 weeks. Refer prt to doctor for specific dosage and use instructions Refer prt to doctor or pharmacist to discuss dosage or side effects. Bupropion SR (Wellbutrin / Zyban) Bupropion SR (Wellbutrin / Zyban)... No (Rx) Contains no nicotine. Is thought to work on the dopaminergic pathways of the brain. Easy to take (once or twice daily) Contains no nicotine NRT may be added to the use of bupropion to increase effectiveness Has potential for some side effects, the biggest of which is risk of seizure. Most common side effects: Dry mouth, insomnia, anxiety/agitation FDA boxed warning (FDA Alert) About $1 per pill Pg.6

8 Chantix (Varenicline) Recommended course of therapy is 12 weeks. Refer prt to doctor for specific dosage and use instructions Take with 8oz water and food to reduce nausea potential. Refer prt to doctor or pharmacist to discuss dosage or side effects. Available only as Chantix (no generic brands) Chantix... No (Rx) Contains no nicotine. Binds to acetylcholine receptors and provides a moderate release of dopamine. Blocks the ability of nicotine to activate these receptors, thus reducing the reward potential of smoking. Has been demonstrated as effective or more effective that Bupropion in clinical trials. Contains no nicotine. Take in pill form twice daily. Most common side effect is nausea. Less common side effects include: sleep disturbance, constipation, vomiting FDA boxed warning (FDA Alert) About $4 per day Pg.7

9 Cessation Medicine Reference Guide