Smoking Cessation Drugs: Nicotine Replacement Products
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Smoking Cessation Drugs: Nicotine Replacement Products

Type of Medication:

Nicotine replacement

Medications and Their Commonly Used Brand Names

Type of medicationBrand name
Nicotine patch/transdermal nicotine Habitrol
NicoDerm CQ
Nicotrol
ProStep
Nicotine gum/lozengesNicorette/Commit
Nicotine nasal sprayNicotrol NS
Nicotine inhalerNicotrol Inhaler

What They Are Prescribed For

Nicotine replacement products are used to help people stop smoking. These products work best as part of a program that also includes education, counseling, and/or psychological support.

How Nicotine Replacement Products Work

These products provide nicotine without the cigarette, and help to wean your body off of nicotine. The typical effects of withdrawal are minimized as your body adjusts to not smoking and progressively lower doses of nicotine, until the use of the nicotine replacement product is stopped completely.

  • Nicotine patch releases nicotine through your skin and into your bloodstream.
  • Nicotine gum is chewed slowly, and then stored between the gum and cheek so that the nicotine can be absorbed through the lining of your mouth and into your bloodstream.
  • Nicotine lozenges are allowed to dissolve slowly in your mouth to release nicotine at a slow sustained rate.
  • Nicotine nasal spray contains small doses of nicotine that are sprayed into your nasal passages and absorbed into your bloodstream.
  • Nicotine inhaler contains nicotine that is inhaled through the mouth and is absorbed in the mouth, throat, and lungs.

Precautions While Taking These Medicines

Do Not Smoke

Nicotine can build up to toxic levels if you smoke while using a nicotine replacement product.

See Your Doctor

Patches and gums can be purchased over-the-counter, but the nasal spray and inhaler require a prescription. Your doctor will help you determine the appropriate dosage. Also, your doctor can prescribe additional smoking cessation aids and can refer you to a counselor, support group, or other services that may help you quit smoking. People who combine several quitting strategies often have the most success.

Don't Overuse These Products

  • Nicotine patch—Do not use for longer than 12 weeks.
  • Nicotine gum/lozenges—Do not chew or use more than 24 pieces a day, and do not use for longer than six months.
  • Nicotine nasal spray—Do not use for longer than three months.
  • Nicotine inhaler—Do not use for longer than six months.

Don't Use During Pregnancy or When Breastfeeding

Nicotine, regardless of the source, is potentially dangerous during pregnancy and breastfeeding. Therefore, talk to your doctor about other means of quitting smoking if you are presently or will soon be pregnant or breastfeeding.

Be Careful Around Children

Children can be seriously harmed by any amount of nicotine. Keep these products, including used patches, away from children.

Use With Adolescents and Older Adults

Nicotine replacement products are believed to be safe for adolescents and older adults. People with dentures, though, should avoid using nicotine gums.

Manage Your Medications

Tell your doctor about all the medications you take; some should not be taken when you are quitting smoking with nicotine replacement products, while others may require a different dosage level. The following are especially important for your doctor to know about:

  • Bronchodilators (Aminophylline, Oxtriphylline, Theophylline)
  • Beta-adrenergic blocking agents (with nasal spray only)
  • Insulin
  • Prazosin (Minipress)
  • Propoxyphene (Cotanal-65, Darvon)
  • Isoproterenol (Isuprel, Medihaler-Iso)
  • Phenylephrine (Alconefrin, Doktors, Duration, Neo-Synephrine, Nostril, Rhinall, Vicks Sinex)
  • Tricyclic antidepressants (with inhaler only)
  • Nasal decongestants (nasal spray only)
  • Foods and medications containing caffeine

Be Cautious With Certain Medical Conditions

The presence of other medical conditions may affect the use of nicotine replacement products. Tell your doctor if you have any other medical problems, especially the following:

Proper Usage

Nicotine Patch

  • Nicotine patch products vary in strength, number of patches, and time they should be worn. Talk with your doctor about the specific dosage and strength of nicotine patch that is appropriate for you, and how to taper off the product.
  • Read the instructions that come with your specific patch to learn how and where to apply your patch.
  • Keep the patch on even when you are showering, bathing, or swimming.
  • Nicotine patches should be removed from the skin during strenuous exercise. If a patch is left on, too much nicotine may pass through your skin and into your bloodstream.
  • If you are using a 24-hour patch and begin having unusual dreams or disturbed sleep, you may take the patch off before going to bed and put a new one on when you wake up in the morning.
  • Mild itching, burning, or tingling may occur when the patch is first applied, and should go away within 24 hours. After a patch is removed, the skin underneath it may be red. It should not remain red for more than a day. If you get a skin rash from the patch, or if the skin becomes swollen or very red, call your doctor. Do not put on a new patch.

Nicotine Gum and Lozenges

  • Read the instructions that come with the nicotine gum or lozenges to learn how to use it properly.
  • The proper dosage differs for each person. Talk with your doctor to determine the appropriate dosage and weaning schedule for you.
  • Do not drink acidic beverages, such as citrus fruit juices, coffee, soft drinks, or tea within 15 minutes before or after, or while you are using the product. Acid, as well as caffeine, can interfere with nicotine absorption.
  • Carry nicotine gum or lozenges with you at all times in case you feel the sudden urge to smoke.

Nicotine Nasal Spray and Inhaler

  • Read the instructions that come with the nasal spray to learn how to use it properly.
  • The proper dosage differs for each person. Talk with your doctor to determine the appropriate dosage and weaning schedule for you.
  • For the nasal spray only: During the first week of use, you may have a hot, peppery feeling in the back of your throat or nose; coughing; runny nose; sneezing; or watery eyes. Do not stop using the nasal spray at this point; if you continue to use it regularly, your body will adjust to these effects. However, if these effects do not lessen after one week, check with your doctor.
  • For the inhaler only: The nicotine inhaler should be used at or above room temperature. Cold temperatures decrease the amount of nicotine you inhale.

Possible Side Effects

The side effects listed here have been reported for at least one of the nicotine products, not necessarily all of them. However, since many of the side effects of nicotine products are similar, it is possible that these side effects may occur with any one of these medicines, although they may be more common with some than with others.

Contact your doctor as soon as possible if any of the following side effects occur.

These side effects are considered more common:

  • Feelings of dependence
  • Injury or irritation to the mouth, teeth, or dental work (with gum only)
  • Swelling of gums, mouth, or tongue
  • Chest pain or tightness
  • Tingling in arms, legs, hands, or feet

These effects are considered less common:

  • Burning, tingling, or prickly sensation in nose, mouth, or head
  • Confusion
  • Difficulty swallowing
  • Dizziness
  • Dryness or pain in throat
  • Fast or irregular heartbeat
  • Fever and/or chills
  • Severe or worsening headache
  • High blood pressure
  • Joint or muscle pain
  • Nasal blister or sore
  • Nausea and/or vomiting
  • Numbness of nose or mouth
  • Trouble breathing or wheezing
  • Skin rash, itching, or hives

Symptoms of Nicotine Overdose

Contact your doctor immediately if you experience any of these symptoms (which will probably occur in this order):

  • Nausea and/or vomiting
  • Increased watering of the mouth (severe)
  • Abdominal or stomach pain (severe)
  • Diarrhea (severe)
  • Pale skin
  • Cold sweat
  • Headache (severe)
  • Dizziness (severe)
  • Disturbed hearing and vision
  • Drooling
  • Tremor
  • Confusion
  • Weakness (severe)
  • Extreme exhaustion
  • Fainting
  • Low blood pressure
  • Difficulty in breathing (severe)
  • Fast, weak, or irregular heartbeat
  • Convulsions/seizures
  • Death

Check with your doctor if any of the following side effects occur frequently and/or become bothersome:

  • Back pain
  • Belching (with gum only)
  • Constipation
  • Mild to moderate headache
  • Hot, peppery feeling in the back of the throat or nose (with nasal spray)
  • Increased appetite
  • Increased watering of mouth (with gum only)
  • Indigestion
  • Nausea
  • Jaw muscle ache (with gum only)
  • Redness, itching, and/or burning at site of application of patch
  • Runny nose
  • Sneezing
  • Sore mouth or throat (with gum only)
  • Watery eyes

Smoking Cessation Success

It is very clear from all of the studies on smoking cessation that your chances of long-term success depend a great deal on your motivation and commitment to quitting, regardless of which therapy you choose.

RESOURCES:

American Cancer Society
http://www.cancer.org

Smokefree.gov
http://www.smokefree.gov

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html

Healthy Living Unit
http://www.phac-aspc.gc.ca/pau-uap/fitness/



Last reviewed August 2007 by Edward R. Rosick, DO, MPH, MS

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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