Nicotine Replacement Therapy: Administration and Overview
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Nicotine Replacement Therapy: Administration and Overview
Barbara Hart, MPA and Claudia Lechuga, MSBronx BREATHEST: (718)430-2601
E: [email protected] / [email protected]
June 15, 2009
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Smoker Assessment
• History of usage• Previous quit attempts
– Withdrawal/abstinence symptoms• Motivational level for quit attempt• Current social environment
– Stressors– Triggers– Biological/medical assessment– Family and friend support/sabotage
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Previous Quit Attempts
• Dates• Age• Method used to quit
– Medications or counseling used (if any)• Duration of that method• Problems and successes experienced• Reason for relapse• Withdrawal/Abstinence Symptoms
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Current Quit Attempt
• Motivational Level– Confidence
• Main reason for considering/wanting to stop• Concerns about quitting
– Weight gain concerns
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Use of NRT
Reasons for using NRT• Doubles the success rate• Treats nicotine withdrawal
– Helps patient feel more comfortable
• Safe– Patient receiving same drug
(nicotine) in a less addictive form over a relatively short period
Reasons for NOT using NRT• Medical conditions requiring
caution/physician input– i.e. recent MI, pregnancy,
current arrythmia• Age
– Under 18s require physician/parental input
• Specific issues– Allergy to patches– Personal aversion to medication
• Questionable efficacy– i.e. those smoking less than
10pd
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Tobacco Cessation Medications
Nicotine Replacement• Patch *• Gum *• Lozenge *• Oral Inhaler ^• Nasal Spray ^
Non-nicotine medication• Bupropion ^
– (Zyban/Wellburtrin)
• Varenicline ^– (Chantix)
* Available OTC ^ prescription only
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Nicotine Delivery Comparison
Nicotine Delivery DeviceNicotine in Product
Approx Amount of Nicotine Delivered to
UserComments
Marlboro Red 13 mg 1-3 mgMarlboro Light 13 mg 1-3 mgCigars 10-40 mg Highly Variable
Moist Snuff 3-12 mgVaries depending on pH and other characteristics
Nicotine Gum 2 mg piece Up to 0.8 mgNicotine Gum 4 mg piece Up to 1.5 mgNicotrol Patch (Pharmacia) 15 mg / 16 hoursNicoderm CQ Step 3 (Glaxo Smith Kline) 7 mg / 24 hoursNicoderm CQ Step 2(Glaxo Smith Kline) 14 mg / 24 hoursNicoderm CQ Step 1(Glaxo Smith Kline) 21 mg / 24 hours
Tobacco Products
Nicotine Replacement Products
Only delivers nicotine to the consumer
Also delivers a wide range of carcinogens and other
toxins
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Medication Overview
Product Use Advantages Disadvantages Precautions Side Effects CostNicotine Patch
Apply each day to clean, dry, hairless skin. Start 21 mg patch if .10 cig per day; can taper to 14 mg in 4-6 weeks, then 7 mg in 2 weeks if no cravings
Place and forget; over the counter; can decrease morning cravings if worn at night
Passive - no actions to take when craving occurs
Not recommended to use while smoking; caution within 6 weeks of heart attack
Skin reaction (50% of patients; usually mild and can use hydrocortisone cream); Rotate sites; vivid dreams or sleep disturbances possible at night
$45/2 week supply (generics available and effective)
Nicotine Gum
Chew every 1-2 hours as needed; chew and park; 2 and 4 mg strength (4mg if around 1 ppd)
Use as needed; can self-dose; Over the counter
Difficult to chew Avoid food and acidic drinks 15 minutes before and while using (decreases absorption)
Jaw pain; nausea if swallowing saliva
$35-50/2 week supply
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Use and Efficacy of combination therapy
• Multiple patch therapy (42 vs 21mg)– 20% increased abstinence– No significant increased sleep disturbances– (Dale 1995; Jorenby 1995)
• Patch + Gum– Kornitzer 1995; Puska 1995
• Early better rates – 7% increase at 6 months
• Not sustained at 1 year• No increase in adverse events
– 2008 OHS Guidelines Meta-analysis• Path + Gum/Spray OR = 1.9
– Compared to patch alone (OR=1)
– Fiore 2008• Abstinence rates
– Nicotine Patch = 23.4%– Nicotine Gum = 19.0%– Long term Patch + Gum = 36.5%
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Important Points about NRT
• Nicotine is the addictive part of tobacco smoke but NOT the most dangerous part
• People do NOT generally become addicted to medication
• People DON’T use enough medication or stop TOO EARLY– Medications are SAFE and EFFECTIVE– Plan on minimum of 2 months of medication
• Combinations– Work better than single medications
• Use Long acting + Short acting
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NRT Kits Available
Moderate Smokers• Smoke 10-20 per day• Includes:
– Novartis Step 1• 28 count 21 mg patches
Heavy Smokers• Smoke 20+ per day• Includes:
– Nicorelief Gum• 110 pieces of 4mg gum
– Novartis Step 1• 28 count of 21mg patches
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NRT Enrollment Forms
Necessary for each course distributed
Full information required
Fax or email back to Bronx BREATHES
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NRT Enrollment Forms (cont’d 1)
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NRT Enrollment Forms (cont’d 1)
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NRT Enrollment Forms (cont’d 1)