Pharmacological treatment

Nicotine replacement therapy, which should be used in conjunction with an educational support program, has been proved to be effective and is available as chewing gum or transdermal patches (the preferred method). Ideally the nicotine should not be used longer than 3 months.

Nicotine gum 3

This is available as 2 mg and 4 mg.

• Low dependence (less than 10 cigarettes per day): use non-pharmacological methods rather than replacement

• Moderate dependence (10-14 cigarettes per day): 2 mg

• High dependence (> 15 per day): 4 mg initially, changing to 2 mg after 4-6 weeks. Useful points

• Chew each piece slowly for about 30 minutes.

• Ensure all the nicotine is utilised.

• Chew at least 6 pieces per day, replacing at regular intervals (not more than 1 piece per hour)

• Use for 3 months, weaning off before the end of this period.

Transdermal nicotine 3

This is available as 16-hour or 24-hour nicotine patches in three different strengths. The patients should stop smoking immediately on use.

Recommendations

• Moderate dependence: 14 mg patch; change to 7 mg patch after 4-6 weeks

• High dependence: 21 mg patch; change to 14 mg patch after 4-6 weeks

Apply to non-hairy, clean, dry section of skin on upper outer arm or upper chest and leave in place for

24 hours. Rotate sites with a 7-day gap for reuse of a specific site.

Contraindications

These are pregnancy and breast-feeding, children, severe myocardial ischaemia, arrhythmias or recent CVA.

General Practice, Chapter 18

Adverse reactions

• Gum: hiccoughs, orodental problems, jaw pain, gastrointestinal including exacerbation of peptic ulcer

• Patches: local reaction, sleep disturbances (use 16-hour patch for this)

• Both: nervousness, sweating, dry mouth, dyspepsia, abdominal cramps, angina and arrhythmias

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