Nicotine Replacement Therapy, Zyban and Champix
Nicotine Replacement Therapy (NRT) - Rationale for use Nicotine is highly addictive and causes unpleasant withdrawal symptoms which often undermine a quit attempt NRT only contains nicotine and provides a weaning effect to help alleviate these symptoms Nicotine is delivered much more slowly and at lower levels than from inhaled smoke
Evidence of efficacy Most tried and tested treatment, in many different settings and with many different patient groups Doubles the chance of success All products equally effective
Safety All NRT can be used by patients with virtually all medical conditions NRT can be used by children from aged 12 years as well as pregnant/breastfeeding smokers More than one form of NRT can be used at the same time and used for at least 8 weeks but preferably 12 weeks.
Nicotine provided by NRT products With average smokers, NRT provides 50% of daily intake Nicotine in these doses is considered harmless (Unfounded concerns about NRT safety can be a barrier to its use) Dependence on NRT less likely because of lower speed of absorption
Nicotine Replacement Therapy Products Patch Mouth Spray Microtab Gum Inhalator Nasal Spray Lozenge Mouth Strips All products are effective it is just a question of what suits the person best
How do NRT products vary? Speed of absorption, ease and frequency of use and side effects Amount of behavioural replacement and sensory effects Potential to obtain nicotine dose required
Patch (Transdermal) (1) 24 hr in 21mg,14mg,7mg or 16 hr in 25mg,15mg,10mg Both equally effective and takes 8 hours to reach plateau 24 h patches can cause vivid dreams Side effects can be skin irritation and sleep disturbance
Patch (2) Use a new patch each morning and warm patch before use and wave it about before use as this help it stick For use on any hairless part of body such as upper arm, side of torso. Do not put on the same place as there will be some redness which is normal In case of allergic skin reaction stop using immediately and change product
Advantages of the Patch Easy to use and discreet No social acceptability problem and has a better compliance Provides a slow sustained level of nicotine ideal for habitual smoking
Lozenge 2mg and 4mg strengths Use hourly, top up if needed plateau reached between 20-30 minutes Dissolves in mouth, move from side to side and rest between cheek and gum Side effects can cause hiccups, gastritis
Gum 2mg and 4mg (plain, mint, fruit, soft or candy coated shell) Nicotine levels peak in 20-30 minutes 1 piece per hour (10-15 pieces per day ) using chew and park technique Side effects can cause hiccups, gastritis and jaw ache
Microtab Dissolves under tongue in 20 minutes Plateau reached between 20-30 minutes Dose: 15-30 2mg tabs per day Side effects can cause stinging in mouth, gastric upset or hiccups
Inhalator Absorbed through mouth like gum and lozenge and warming the cartridge improves delivery 30 minutes to reach plateau 10 puffs = 1 puff from a cigarette and each cartridge lasts for at least 3 puffing sessions
Mouth Spray Use when cravings emerge, up to 4 spays an hour (maximum of 64 sprays a day) Has a peppermint flavour and provides 58% more nicotine compared to 4mg lozenge or gum Relieves cravings within 60 seconds 3 times faster than other oral products
Mouth Spray Directions for use When using for the first time, point the nozzle away and press the top of the dispenser several times until a fine spray appears. If spray is not used for 2 days or more, this need to be repeated. Point the spray nozzle towards the side of an open mouth, holding it as close as possible. Press the top of the dispenser to release one spray To avoid getting spray down the throat, don t inhale while spraying and don t swallow for a few second after spraying
Mouth Strips Nicotine mouth strips start to relieve the urge to smoke in 50 seconds Strips have a fresh, minty flavour and dissolve in approximately 3 minutes for fast release of nicotine. They come in a single strength (2.5mg) for use with light smokers who smoke their first cigarette 30 minutes or more after waking
Mouth Strips How to use For weeks 1 to 6 of quitting, users are recommended to take 1 nicotine strip every 1-2 hours For weeks 7-9 of quitting users are recommended to use 1 nicotine strip every 2-4 hours For weeks 10-12 quitting users are recommended to use a 1 nicotine strip every 4-8 hours Usage should not exceed 15 oral strips per day
Nasal Spray Takes only minutes to reach plateau but need to warn of initial aversive effects & supervise the first trial, reassure they will get used to it after a few days (can cause nasal and eye irritation) Recommend one shot in each nostril hourly (but no more than 64 sprays in 24 hours) Recommend use for up to 8 weeks then reduce dose for the last 4 weeks Especially useful for highly dependent smokers who can tolerate it
Advantages of Oral Products Faster nicotine delivery with more control over nicotine dose Can be used opportunistically to help resist the urge to smoke Helps with relapse prevention For best results use a patch and an oral product
NRT improving success rates Motivation essential Provide clear rationale plus instructions on use Ensure patient is aware of: Unrealistic expectations Under-dosing Irregular use Stopping too early Concurrent smoking All products are available on prescription
Summary NRT is not a magic cure - effort and determination are still crucial but NRT will reduce withdrawal symptoms All products should be used for at least 8 weeks but for the best results 12 weeks All products are equally effective - try to find which one suits individual best
Other Medication There are other medications that can be offered via a prescription from a GP: Varencline (Champix) Bupropion (Zyban)
Champix (Varenicline) A drug specifically designed for smokers Launched in December 2006 NICE Guidance final report July 2007 recommending use for smokers Plus behavioural support
Champix efficacy and usage Studies have been conducted showing it to be more effective than NRT Side effects main one nausea Use for 12 weeks: Days 1-3: 0.5 mg once daily Days 4-7: 0.5 mg twice daily Day 8 - end of treatment: 1 mg twice daily A quit date is set between days 8 to 14.
Champix How Champix Works 1 Nicotine from a cigarette stimulates the release of dopamine - a substance produced by the brain which triggers feelings of pleasure When a smoker quits, the lack of nicotine leads to reduced levels of dopamine causing feelings of craving and withdrawal Champix both blocks the nicotine receptors (reducing the addictive power of the drug) and triggers moderate dopamine release to alleviate withdrawal symptoms
Champix How Champix Works 2
Zyban (Bupropion) Zyban was initially developed to treat depression in US Alters the level of some chemicals in the brain (neurotransmitters) to relieve cravings & other withdrawal symptoms Many contraindications so it isn t suitable for all smokers, can work well if prescribed correctly
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