I have to follow the standard dosing recommendations from the product manufacturer. Nicotine replacement therapy is available as a nicotine patch, gum, lozenge, inhalator and mouth spray. Press patch firmly in place for 10 seconds so it will stick well to your skin. All forms of nicotine replacement therapy gum, transdermal patch, spray, inhaler, and lozenge are equally effective, increasing smoking cessation rates by about 150% to 200%. Patients should wash their hands after applying or removing the patch. Combination treatment with varenicline and nicotine. Nrt that controls cravings and withdrawal symptoms. Combination nrt consists of using both the nicotine patch a longacting form of nrt and a shortacting nrt of the patients choice, generally nicotine gum or nicotine lozenge. When compared to nicotine patches, only the 2mg varenicline and the combination of longterm patch plus as needed nrt gum or spray were found to have abstinence rates significantly better than patches alone. Estimated 6month abstinence rates comparing nrt monotherapy gum, patch, inhaler, lozenge, nicotine patch plus as. Dosing is based on using patch in combination with gum. Read more about nicotine patches, nicotine gum and nicotine lozenges.
Pros flexible dosing mimics the handtomouth behavior of smoking few side effects. Odds ratio for varenicline alone and the combination of patch plus gum or spray. Five nicotine replacement therapy nrt products represent short acting agents with nicotine gum, nicotine patches and lozenges available over the counter and nicotine nasal spray and nicotine vapor inhaler by prescription only. A study in the journal american family physician found smokers who used nrt were 2. Smoking reductioncessation medication dosing fact sheet. Nicotrol ns nicotine dose, indications, adverse effects. The risk of seizure with bupropion use is dosedependent and is most. Combining nrt patch with other forms of nrt yields higher. Now, you can power up your patients quit journey by combining nicoderm and nicorette products. The patch provides longacting nicotine to manage nicotine withdrawal, and the gum is used as an adjunct to address withdrawal symptoms not managed by the patch.
Otherwise, all nrt products otherwise, all nrt products including the inhalator and mouth spray can be purchased over the counter from supermarkets or pharmacies for the normal retail price. Recent trials found that optimised nrt using both patch and lozenge yielded greater longterm abstinence than monotherapy with nicotine patch or bupropion. The mean age of these smokers was 53 years sd 10, and 57% were female. In addition to the nicotine nasal spray plus nicotine patch study, 24 2 other studies, both of which used nicotine chewing gum plus nicotine patch, have evaluated the efficacy of combination nrt for smoking cessation. Apply a nicoderm patch in the morning for steady, allday support against withdrawal symptoms, and use your choice of nicorette gum, quickmist or lozenge to tackle your toughest cravings.
When applying a new patch, open the pouch and remove the backing, then apply to the skin and hold the patch to the skin for 10 seconds. Nicotine replacement therapy has an established safety and efficacy record in over 150 clinical trials and increases quit rates by about 60% compared to placebo. Combination nrt is the use of nicoderm patch plus an additional form of shortacting nicorette oral nrt gum, lozenge, inhaler, quickmist on an as needed basis. Combination therapy quit smoking with our products. Using the nicotine patch plus another nicotine replacement therapy nrt product improves.
Taking into account the 39,068 people prescribed nrt patch during the study period with a history of nrt at baseline excluded from the analysis, the total proportion of people prescribed nrt. Bupropion alone or with a nicotine patch increased smoking. Smoking is the number one cause of preventable disease and death in the united states. Learn more about combination nrt estimated 6month abstinence rates comparing nrt monotherapy gum, patch, inhaler, lozenge, nicotine patch plus as needed inhaler, gum or lozenge, bupropion monotherapy and in combination with nrt, and varenicline monotherapy. Some smokers find they have more success by starting with combination therapy straight away, rather than waiting to see if one product is enough on its own. Delivers doses of nicotine approximately 25% higher than nicotine. Sequential therapy can theoretically provide initial stable nicotine dosing to. Nicotine replacement therapy ukanquit recommends combination therapy patch plus short acting nrt patch, gum, lozenge, inhaler, or nasal spray cessation medication dosing information combination therapy is the most effective 1. Combined nicotine patch with gum versus nicotine patch alone in. Combination of varenicline and nicotine patch for smoking. Just as with a single form of nicotine replacement therapy, 812 weeks is the recommended timeframe for combination nrt. Both varenicline and nicotine replacement therapy nrt help achieve smoking cessation.
People who use a combination of nicotine replacement therapies are. Alternatively, the combination of a nicotine patch with bupropion sr has also been. May be used in combination with nrt nicotine patches, spray, gum and inhaler. However, ongoing need should be assessed and more nrt given as required. Odds ratio for varenicline alone and the combination of patch plus gum. Nicorette lozenge, nicorette mini lozenge nicotine lozenge. If patient requests gum only after understanding rationale for patch, order as per patient preference. Smoking is a major preventable cause of morbidity and premature death worldwide.
Expired carbon monoxide co monitoring is helpful to more accurately recommend an nrt strength and dosage. Combination nrt consists of using both the nicotine patch a longacting. However, using singletype nrt is a reasonable alternative based on cost, side effect profiles, and patient preference. Learn more about combination nrt estimated 6month abstinence rates comparing nrt monotherapy gum, patch, inhaler, lozenge, nicotine patch plus as needed inhaler, gum or lozenge, bupropion monotherapy and in combination with nrt, and varenicline. Prescribe 2mg or 4mg gum or lozenge according to dosedependence level described above on an asneeded basis. For patch dose comparisons, evidence was of moderate certainty, due to imprecision. Guide to prescribing nicotine replacement therapy ministry of. The patch delivers a steady stream of nicotine for 24 hours, so you get longacting, consistent relief from withdrawal symptoms, such as headaches and. The first nonnicotine medication approved for smoking cessation sustainedrelease atypical antidepressant inhibits the reuptake of the dopamine and norepinephrine in the brain, decreasing the cravings for cigarettes and symptoms withdrawal can be used in combination with nicotine patch. To dispose of patch, fold the old patch in half with the sticky sides. Dosing 24hour patch 40 cpd 42 mg per day 29 cpd 2835 mg per day. All nicotine patches contain the same dose of nicotine. Nicotine replacement therapy and adolescent patients. Recommendations for use of combination therapy in tobacco.
Combination therapy of varenicline with nicotine replacement. Nicotine replacement therapy, which includes nicotine skin patches, sprays, tablets, inhalers and gum, can make an enormous difference in your ability to quit smoking. Nicotine replacement therapy dosing guidance help them quit. Nrt is safe and effective in helping adults quit tobacco use. Nicotine replacement therapy nrt gives you nicotine in the form of gum, patches, sprays, inhalers, or lozenges but not the other harmful chemicals in tobacco.
Combining nrt formulations allows the patient to tailor therapy as needed based on specific environmental or emotional triggers. Avoid wearing patch on same area more than once per week. Guide to prescribing nicotine replacement therapy nrt. Different doses, durations and modes of delivery of nicotine. Brief instructions adapted with permission from the tobacco treatment medication dosing chart at the partnership for a tobaccofree maine. Two principal types of combination pharmacotherapy have been used and evaluated for increasing smoking abstinence rates among cigarette smokers. No single nicotine replacement therapy is most effective for all smokers. Dosing recommendations, tapering strategies, and behavioral interventions. The gum should be chewed slowly until a tingling sensation is felt, and then the gum should be parked between the cheek and gums. Nicotine replacement therapy ukanquit recommends combination. Nicotine replacement therapy right path addiction treatment. Mayo clinic ndc tobacco dependence treatment medication. What is the most effective nicotine replacement therapy. The patches give you a steady dose of nicotine all day, whereas the.
Nrt users should still pick a day to quit smoking, and begin using the otc nrt product on their quit day, even if they arent immediately able to stop smoking it is important for patients to complete the full program, but some patients may need to use the nrt for a longer period of time to keep from smoking. I have to chew my nrt gum in a specific way in order to achieve the optimal effects. Fdaapproved medications for smoking cessation nicotine replacement therapy nrt formulations bupropion sr varenicline gum lozenge transdermal patch nasal spray oral. Nicotine patches nicabate p, nicorette, nicotinell step 1. Nicotine replacement therapy guidance document final. The patch, gum and lozenges are subsidised if supplied on prescription or via the quit card programme. You can bathe, shower or swim while wearing the patch. Pharmacotherapy for smoking cessation in adults uptodate. The aim of this research was to investigate the efficacy and safety of varenicline combined with nrt. Otherwise, all nrt products including the inhalator and mouth spray can be purchased over the counter from supermarkets or pharmacies for the normal retail price. Nrt can help relieve some of the physical withdrawal symptoms so that you can focus on the psychological emotional aspects of quitting. A controlled trial of sustainedrelease bupropion, a nicotine patch, or both for smoking cessation. The nicotine patch can be combined with a short acting nrt gum, lozenge, nasal spray or inhaler. At 4 weeks, combined nrt group was more likely to quit smoking or 1.
Some clients will require more than one patch or a combination of patch and oral nrt see tool 4 flowchart for nrt use in hospital. Used together, a combination of the nicotine patch and nicotine gum or the nicotine patch and nicotine lozenge can provide much better relief from nicotine cravings than when they are used alone. The patch should be applied to dry, clean, hairless area every 24 hours. Based on the favorable evidence, pharmacology, and safety of combination nrt, we suggest that the following regimen be initiated in patients with low to high nicotine dependence who want to quit smoking. Nicotine inhaler and nicotine patch as a combination therapy. However, limited evidence exists regarding whether combination of varenicline and nrt is more effective than either alone. Recommendations for use of combination therapy in tobacco use.