Nicotine replacement therapies Nicotine replacement therapies (NRT) are designed to replace nicotine obtained through smoking in order to attenuate tobacco withdrawal symptoms and improve smoking cessation outcomes. There are currently five Food and Drug Administration (FDA)-approved NRT products, which include: the transdermal patch, gum, lozenge, inhaler, and nasal spray. These products are available over-the-counter or by prescription. They can be
given alone or taken in conjunction with antidepressants like bupropion in order to alleviate Inhibitors,research,lifescience,medical acute with-drawal symptoms and sustain abstinence. A small dose of nicotine in these products allows the patient to reduce nicotine withdrawal symptoms after the patient has stopped smoking. Patients are often counseled to quit, Inhibitors,research,lifescience,medical provided options for treatment, and helped to establish a quit date. On the quit date the NRT is started and other forms of tobacco use are stopped.6 Choice of specific NRT typically depends on the patient’s preference, the side-effect profile, and the route of administration.7 The nicotine transdermal patch is available in 16- Inhibitors,research,lifescience,medical or 24- hour Fasudil molecular weight delivery systems. Recommended duration of use is 6 to 12
weeks, with a tapering of the patch dose over that period. Patients usually start with a high-dose patch (21 or 22 mg); however, an intermediate-dose patch (11 or 14 mg) is available for those who smoke fewer than 15 cigarettes per day.5 Though patients usually develop tolerance to common side effects, they may experience insomnia, nausea, and vivid dreams. Skin irritation can also occur, and is usually alleviated with rotation of the patch placement site.8-11 The nicotine patch can also be utilized in combination with other NRT, such as the gum, which increases Inhibitors,research,lifescience,medical its efficacy in treatment-resistant cases.12 Nicotine polacrilex gum and lozenges are available Inhibitors,research,lifescience,medical over- the-counter as aids in smoking cessation in 2 and 4 mg doses of nicotine. The 4-mg dose is recommended for heavy smokers (>25 cigarettes per day).8,13,14 The recommended dosage of nicotine gum is to use one piece every 1 to 2 hours.6 The nicotine lozenge should be sucked on rather than chewed. The Parvulin lozenge delivers
about 25% more nicotine than the gum, since some nicotine is retained in the gum and the lozenge is dissolved completely.15 The dose can be tapered over 6 to 12 weeks by either decreasing the gum or lozenge dose from 4 mg to 2 mg or by increasing the time between doses,6 with peak concentrations of nicotine absorbed through the buccal mucosa achieved in 15 to 30 minutes.16,17 Nicotine absorption can be blunted with use of acidic beverages; therefore, coffee, juices, and soda should be avoided immediately before or during NRT use.18 Side effects of the gum may include jaw soreness or difficulty chewing.13,19 The lozenge offers an alternative to gum but also may elicit side effects such as nausea, heartburn, and mild throat or mouth irritation.