Tobacco withdrawal Withdrawal symptoms are often a barrier to stopping tobacco use, which is often due to nicotine deprivation. Withdrawal symptoms begin within 24 hours of abruptly quitting tobacco and include ● Irritability, frustration, or anger. ● Anxiety. ● Difficulty concentrating.
the treatment of nicotine addiction. 55 Although thought to be beneficial, NRT must be initiated with caution and the most recent clinical practice guideline suggested cautious initiation within 2 weeks of acute myocardial infarction. 141 More recently, a study demonstrated that the use of NRT was not associated with any differences in short-term outcomes in smokers hospitalized with coronary heart disease. 142 NRTs come in a variety of delivery systems, and no standard dosing regimens are recommended. Starting at the lower doses available for each NRT is recommended with careful titration upward to control cravings but avoid the side effects associated with nicotine administration. 143 Table 5 represents a sample of NRTs, but it is not an inclusive list, and treatments must be individualized to each patient.
● Increased appetite. ● Depressed mood. ● Insomnia.
Symptom intensity is higher in individuals who smoke cigarettes or use smokeless tobacco but peaks 2-3 days after abstinence and typically lasts approximately 2-3 weeks. However, nicotine replacement therapies (NRT) and other medications are available to augment
Table 5: Nicotine Replacement Therapies NRT Advantages
Disadvantages
Side Effects
Precautions
Nicotine patches
Can be used with other modalities; steady dosing; OTC
Unable to change doses; may need augmented therapy
Headache; sleep disturbances; skin sensitivity
Caution with starting within 2 weeks of MI. Arrhythmia; angina; pregnant or breastfeeding; age <18 years Caution with starting within 2 weeks of MI. Arrhythmia, angina; pregnant or breastfeeding; age <18 years Caution with starting within 2 weeks of MI. Arrhythmia, angina; pregnant or breastfeeding; age <18 years; TMJ disease Caution with starting within 2 weeks of MI. Asthma and chronic lung disease; arrhythmia, angina; pregnant or breastfeeding; age <18 years; TMJ disease Caution with starting within 2 weeks of MI; sinus issues; asthma, arrhythmia, angina; pregnant or breastfeeding; age <18 years; TMJ disease
Nicotine lozenges
Can be used regularly with withdrawal symptoms or urges; can control amount of nicotine delivered; may help substitute for a cigarette in the mouth; OTC symptoms or urges; can control amount of nicotine delivered; may help substitute for a cigarette in the mouth; OTC Can be used regularly with withdrawal symptoms or urges with patches; can control amount of nicotine delivered; may help substitute for a cigarette in the mouth; OTC Can be used regularly; delivers nicotine most rapidly of all NRTs
Use it regularly; do not eat/drink for 15 minutes before using or when the mouth is full; can cause dyspepsia Use it regularly; do not eat/drink for 15 minutes before using or when in the mouth; can cause dyspepsia; may be hard to use with dentures/dental work Use it regularly; do not eat/drink for 15 minutes before using or when the mouth
Nausea; hiccups; insomnia; headache; cough
Nicotine gum Can be used regularly with withdrawal
Mouth/jaw soreness; stomach; hiccups; nausea/vomiting
Nicotine oral inhaler
Mouth and throat irritation; runny nose; cough, headache, hiccups
Nicotine nasal spray
More addictive than other forms of NRT; some do not prefer nasal spray; requires prescription
Nasal irritation; tearing; runny nose, sneezing or cough headache
Book Code: MDCO1025
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