Nicotine Replacement Therapy

(NRT)

<Medications>

<Index>

 

 

 

Definition

- Replacement of cigarette/cigar nicotine by other less addictive means

 

Features

- Doubles quit rates (5% to 10%)

- Available wo prescription

- Patches, inhalers, gum, lozenges or sublingual

-  Patches easiest

-  Gum, inhalers & lozenges quickest to effect

- All but patches contraindicated if CAD, IHD, stroke, PVD or AMI

- Should not smoke whilst on NRT else double dose of nicotine

 

Mechanism

- Delivery of nicotine to reduce cravings

 

Indications

- Smoking cessation

 

Types

- Patches

-  Cease patches after 12/12

-  Dont use 16hr patches overnight

-  Moderate to High dependency: 21mg/24hrs or 15mg/16hrs

-  Low to Moderate dependency: 14mg/24hrs or 10mg/16hrs

-  Not for pts Low dependency (<10/day)

- Gum

-  Cease gum after 12/12

-  Not more than 1/hr

-  Moderate to High dependency: 4gm gum 6-10/day

-  Low to Moderate dependency: 2mg gum 8-12/day

- Inhaler

-  6-12 cartridges/day for 12/12, taper over 6-8/12

-  Cartridges have 20 min worth or smoking (last up to 12hrs)

- Lozenges

-  Moderate to High dependency: 4mg

-  Low to Moderate dependency: 2mg

-  Frequency

-   1 every 1-2hrs weeks 1-6

-   1 every 2-4hrs weeks 7-9

-   1 every 4-8hrs weeks 10-12

-   1 PRN weeks 13-24

-  Max 15/24hrs

- Sublingual

-  Max 40/day taper after 2-3/12

-  Moderate to High dependency: 4mg 1-2/24

-  Low to Moderate dependency: 2mg 1-2/24

- Combination

-  May increase effectiveness vs monotherapy

-  Patch + 2mg Gum

-  Consider if unable to remain abstinent or withdrawal S/S on monotherapy

 

 

Smoking