Nicotine Replacement Therapy Treatment Option

Drug

Dose & Usage Instruction

Adverse Effects

Contraindications

Comments

Dose: 4 mg if ≥25 cigarettes/day OR 2 mg if <25 cigarettes/day

Initial dose: 10–12 pieces per day orally. May increase to 20 pieces per day if needed.

How to use: Place 1 piece of gum in the mouth. Bite down once or twice then park it between the teeth and gums for about 1 min. Repeat when the desire to smoke arises, up to once per min for up to 30 min, then discard piece.

Tapering schedule: At weekly intervals, reduce by 1 piece/day over 3 mo, as withdrawal symptoms allow. Continue for maximum of 6 months.

CNS: depression, anxiety, irritability, insomnia; dizziness, weakness, headache.

Gastrointestinal: changes in taste perception, hiccoughs dyspepsia, nausea, vomiting.

Cardiovascular: hypertension, palpitations, tachycardia, chest pain.Skin: erythema, itching, rash, urticaria.

Respiratory: dyspnea, cough, hoarseness, sneezing, wheezing.

Other: Jaw, mouth or throat soreness.

Life-threatening arrhythmia; severe angina pectoris; history of recent stroke; temporomandibular joint disease; within 2 wk following myocardial infarction.

Relative contraindications: pregnancy, smoking while using this medication (nicotine toxicity), breastfeeding, age <18 y. Caution in hyperthyroidism, pheochromocytoma, insulin-dependent diabetes, active peptic ulcer, uncontrolled hypertension.

Do not chew like regular gum (increased side effects).

Avoid use of acidic beverages and foods (coffee, fruit juices, soft drinks, alcohol) while chewing and 15 min before as this decreases absorption. Favourable dosing flexibility compared to patch.

How to apply: Apply patch to non hairy, clean, dry skin site in upper arm or hip; use a different site each day; avoid using the same site more than once weekly. Apply upon waking and wear 24 h per day

Treatment is divided into 3 components: selection and evaluation of an initial dosage strength, a maintenance phase and a weaning phase. Treatment should be completed in 8 weeks.

Selection and evaluation: Treatment is initiated with HABITROL 21 mg/day or 14 mg/day, depending on the number of cigarettes smoked per day. HABITROL 21 mg/day is usually recommended for smokers with a consumption of more than 10 cigarettes a day. HABITROL 14 mg/day is usually sufficient for smokers with a consumption of up to 10 cigarettes daily. The dosage strength may be adjusted early in the maintenance phase in response to either the appearance of side effects or difficulty in maintaining abstinence.

Maintenance (4 or 6 weeks): If the initial dosage selected was HABITROL 21 mg/day, these patches should be worn for a period of 4 weeks. If the initial dosage selected was HABITROL 14 mg/day, these should be used for a period of 6 weeks.

Weaning (2 or 4 weeks): the goal of a stepwise reduction from HABITROL 21 mg/day to the lowest dosage strength is accomplished by an intermediate step employing HABITROL 14 mg/day for 2 weeks, whereas HABITROL 7 mg/day is employed directly after maintenance on HABITROL 14 mg/day. HABITROL 7 mg/day, designed to reduce nicotine substitution towards the end of therapy and consolidate abstinence, should be worn for 2 weeks. After completing treatment with HABITROL it is advisable for behavioral therapy to be continued.

Local skin reactions: erythema, pruritus, edema, blisters, rash, burning sensation.

CNS: headache, dizziness, paresthesias, insomnia, abnormal dreams, depression, somnolence, anxiety, emotional lability.

Cardiovascular: palpitations, chest pain, blood pressure changes, tachycardia.

Gastrointestinal: abdominal pain, dyspepsia, nausea, diarrhea, constipation, dry mouth, nausea and vomiting, flatulence, stomatitis.

Respiratory: cough, pharyngitis, rhinitis, dyspnea, sinusitis.

Other: myalgia, arthralgia, dysmenorrhea, toothache, sweating, taste perversion.

Life-threatening arrhythmia; severe angina pectoris; history of recent stroke; temporomandibular joint disease; within 2 wk following myocardial infarction; generalized skin disorders (severe eczema or psoriasis); hypersensitivity to topical adhesives or nicotine.

Relative contraindications: pregnancy, smoking while using this medication (nicotine toxicity), breastfeeding, age <18 y; mild atopic or eczematous dermatitis. Caution in hyperthyroidism, pheochromocytoma, insulin-dependent diabetes, active peptic ulcer, uncontrolled hypertension.

Assess therapy in first 2 wk to ensure smoking has been discontinued. If still smoking discontinue patch and refer to physician. 

Check product monograph re. wearing patch during strenuous exercise—varies by product.

Used patches should be folded so that medicated sides are facing inward and discarded safely out of reach of children or pets.Manufacturer does not recommend cutting patches as this may damage the delivery device.

Patients who experience insomnia from the 24–hour patch may benefit from removing the patch at night and using an immediate-release product first thing in the morning, then applying a new patch.