Nicotine Replacement Therapy:
Administration and Overview
Barbara Hart, MPA and Claudia Lechuga, MS
Bronx BREATHES
T: (718)430-2601
E: bhart@aecom.yu.edu / clechuga@aecom.yu.edu
www.bronxbreathes.org
June 15, 2009
Smoker Assessment
• History of usage
• Previous quit attempts
– Withdrawal/abstinence symptoms
• Motivational level for quit attempt
• Current social environment
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–
–
–
Stressors
Triggers
Biological/medical assessment
Family and friend support/sabotage
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
Current Quit Attempt
• Motivational Level
– Confidence
• Main reason for considering/wanting to stop
• Concerns about quitting
– Weight gain concerns
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
Tobacco Cessation Medications
Nicotine Replacement
• Patch *
• Gum *
• Lozenge *
• Oral Inhaler ^
• Nasal Spray ^
* Available OTC
Non-nicotine medication
• Bupropion ^
– (Zyban/Wellburtrin)
• Varenicline ^
– (Chantix)
^ prescription only
Nicotine Delivery Comparison
Nicotine Delivery Device
Nicotine in
Product
Approx Amount of
Nicotine Delivered to
User
Comments
Tobacco Products
Marlboro Red
Marlboro Light
Cigars
13 mg
13 mg
10-40 mg
Moist Snuff
3-12 mg
1-3 mg
1-3 mg
Highly Variable
Varies depending on pH and
other characteristics
Also delivers a wide range
of carcinogens and other
toxins
Nicotine Replacement Products
Nicotine Gum
Nicotine Gum
Nicotrol Patch (Pharmacia)
Nicoderm CQ Step 3
(Glaxo Smith Kline)
Nicoderm CQ Step 2
(Glaxo Smith Kline)
Nicoderm CQ Step 1
(Glaxo Smith Kline)
2 mg piece
4 mg piece
Up to 0.8 mg
Up to 1.5 mg
15 mg / 16 hours
7 mg / 24 hours
14 mg / 24 hours
21 mg / 24 hours
Only delivers nicotine to
the consumer
Medication Overview
Product
Use
Advantages
Disadvantages
Precautions
Nicotine
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
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)
Side Effects
Skin reaction (50% of
patients; usually mild and
can use hydrocortisone
cream); Rotate sites; vivid
dreams or sleep
disturbances possible at
night
Jaw pain; nausea if
swallowing saliva
Cost
$45/2 week
supply
(generics
available and
effective)
$35-50/2
week supply
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%
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
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
NRT Enrollment Forms
 Necessary for each
course distributed
 Full information
required
 Fax or email back to
Bronx BREATHES
NRT Enrollment Forms (cont’d 1)
NRT Enrollment Forms (cont’d 1)
NRT Enrollment Forms (cont’d 1)