Table 2: Medications for the Treatment of Tobacco Use Medication
Dosage/ Maximum Usage
Duration of Use Start 1-2 weeks before quit date; use for 2-6 months.
U.S. Availability Prescription only: • Generic:
(Dosages Available)
Cautions/Warnings
Side Effects
• Days 1-3: 150 mg each morning. • Day 4 to treatment end: 150 mg twice daily.
• Insomnia. • Dry mouth. • Dizziness. • Nausea. • Diarrhea and constipation. • Anorexia. • Sleep disturbance. • Arthralgia and myalgia. • Rash. • Rhinitis. • Mood changes. • Nausea. • Angioedema. • Sleep disturbances. • Depression and mood changes. • Psychosis.
Bupropion SR (150 mg)
Not for use with: • A monoamine oxidase (MAO) inhibitor. • Bupropion in any other form. • A history of seizures. • A history of eating disorders. • Alcohol, sedative withdrawal. Use with caution with: • Preexisting psychiatric disease. • Severe hepatic cirrhosis. FDA Boxed Warning: See the FDA website for more information Use with caution with: • Significant renal impairment, dialysis. • Psychiatric illness. • Cardiovascular disease. FDA Boxed Warning: See the FDA website for more information
bupropion SR
• Brand: Zyban,
Wellbutrin SR
Start 1 week before quit date; use 3-6 months.
Prescription, brand-name only: • Chantix
• Days 1-3: 0.5 mg every morning. • Days 4-7: 0.5 mg twice daily. • Day 8-end: 1 mg twice daily. For patients with renal impairment or end-stage renal disease undergoing dialysis, dosage will need to be adjusted
Varenicline (0.5 mg, 1 mg)
• Only patch + bupropion is currently FDA- approved. • Follow instructions for individual medications.
See individual medications above.
See individual medications above.
See individual medications above.
See individual medications above.
Combinations: Patch + bupropion Patch + gum Patch + lozenge or inhaler
Note. Adapted from Treating Tobacco Use and Dependence: 2008 Update (clinical practice guideline), U.S. Department of Health and Human Services, May 2008. NICOTINE REPLACEMENT THERAPY
placebo was 1.58.61 The relative risk of abstinence for each type of NRT was 1.43 for nicotine gum, 1.66 for the nicotine patch, 2.00 for lozenges, 1.90 for the nicotine inhaler, and 2.02 for nicotine nasal spray. 61 Based on these data, it can be concluded that use of any of the NRTs can increase tobacco abstinence. However, the clinician should base his or her recommendation for the appropriate form of nicotine replacement on the characteristics of the individual patient. As with all medications, nicotine replacement products should be kept out of reach of children. General contraindications for use of nicotine replacement therapy include patients who have had a heart attack in the past 2 weeks, patients with serious arrhythmias, and patients with serious or worsening angina pectoris. 11 Nicotine replacement therapy has not been approved for use with populations for which there is insufficient evidence of effectiveness (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents). 11 A recent review of the literature suggests that the use of NRT can be effective with patients not ready to quit
There are five forms of nicotine replacement therapy (NRT) available: nicotine gum, nicotine lozenge, nicotine transdermal patch, nicotine inhaler, and nicotine nasal spray. The goal of nicotine replacement therapy is to deliver a sufficient dose of clean pharmaceutical-grade nicotine (free of carcinogens and manufactured under pharmaceutical conditions) to reduce nicotine withdrawal symptoms to a manageable level. All of the commercially available forms of NRT (gum, lozenge, transdermal patch, inhaler, and nasal spray) can increase the rate of quitting by 50% to 70%, regardless of setting. 11 Providing a more intense level of support can facilitate the likelihood that a patient will make a quit attempt. In controlled clinical trials, the experimental group received the active drug and a control group received a placebo. In evaluating the results, a relative risk with a value greater than 1 means that abstinence is more likely to occur in the experimental group than in the control group. Based on analysis of pooled data from multiple controlled clinical trials, the relative risk of abstinence for using any form of NRT compared to a control group receiving a
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