According to the World Health Organization, tobacco kills more than five million people a year. The CDC reports that smoking is the leading preventable cause of death in the United States today. Of the smokers in the United States, 70% desire to quit. Smoking cessation success rates double when tobacco use treatment is utilized.Fortunately for smokers, there is a wide variety of OTC (over-the-counter) nicotine replacement products to assist them in their quest to quit. Nicotine replacement therapy dosage forms include patches, gum, and lozenges. As soon at these OTC nicotine replacement therapies are started, the smoker must completely quit using all tobacco products.
Nicotine Patches
Nicotine replacement patches are the only OTC product to provide a constant release of nicotine throughout the day. The downside of this constant release of nicotine is that the patches do not allow the smoker to respond to acute cravings throughout the day. Therapy with nicotine patches is available in three steps that included the dosages of 21 mg, 14 mg, and 7 mg patches. Smokers that use fewer than 10 cigarettes per day should start on the 14 mg patch for 5 weeks and then decrease to the 7mg patch for 2 weeks.
It is important to never cut nicotine patches or wear more than one patch at a time. Nicotine patches should be applied to clean; dry skin area and the application site should be rotated on a daily basis to help decrease skin irritation, which is the most commonly reported side effect. Some nicotine patch wearers have complained of insomnia and vivid or abnormal dreams . To prevent these side effects, the nicotine patch can be removed at bedtime and a new patch can then be applied every morning.
Nicotine Gum
Nicotine gum is available in 2 mg and 4 mg strengths. For smokers who smoke fewer than 25 cigarettes per day, the 2 mg strength should be used. Those smokers who smoke more than 25 cigarettes per day should use the 4 mg strength.
During weeks 1-6 of nicotine gum therapy, one piece of gum should be chewed every 1-2 hours with at least 9 pieces of gum used per day. During weeks 7-9, one piece of gum should be chewed every 2-4 hours. Finally in weeks 10-12, one piece of gum should be chewed every 4-8 hours. The most common side effects of nicotine gum include upset stomach, unpleasant taste, hiccups, and jaw soreness.
During weeks 1-6 of nicotine gum therapy, one piece of gum should be chewed every 1-2 hours with at least 9 pieces of gum used per day. During weeks 7-9, one piece of gum should be chewed every 2-4 hours. Finally in weeks 10-12, one piece of gum should be chewed every 4-8 hours. The most common side effects of nicotine gum include upset stomach, unpleasant taste, hiccups, and jaw soreness.
Nicotine Lozenges
Nicotine lozenges are available in 2 mg and 4 mg strengths. It is recommended that patients who smoke their first cigarette within 30 minutes of waking up should start with the 4 mg strength lozenge. For all other smokers, it is recommended to start with the 2 mg strength lozenge. It is important to dissolve the lozenge slowly in the mouth and never to chew or swallow the lozenge whole. Food or drink should be avoided for 15 minutes prior to, during, or after using the lozenge. Two lozenges should never be used at one time.
Never use two nicotine replacement therapies at the same time unless directed to do so by your primary care provider. It is generally not recommended to use the nicotine patches, gum, or lozenges longer than 2-3 months, but talk to your primary care provider to assess if a longer amount of therapy is needed.
Never use two nicotine replacement therapies at the same time unless directed to do so by your primary care provider. It is generally not recommended to use the nicotine patches, gum, or lozenges longer than 2-3 months, but talk to your primary care provider to assess if a longer amount of therapy is needed.
Alisia Baker, PharmD
Texas Health Fort Worth
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