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Tobacco Cessation




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Home > Tobacco Use Cessation Program > Didactic Components > Use of Pharmacotherapy in Tobacco Use Cessation

Combined Use of Pharmacotherapy in Tobacco Use Cessation

1st consider using the patch (better compliance & fewer side effects) before other NRT

BUT certain pt characteristics such as:     pt preferences
pt experiences (success or failure) with prior pharmo.
co morbidities (e.g., psychiatric treat)
degree of nicotine dependence
may warrant use of gum, lozenge, spray, inhaler, or Zyban initially

Method for using the patch recommended by the Mayo Clinic Nicotine Dependence Center:

for less than 1/2 PPD.......7-14mg   < can/pouch ST per wk........14-21mg
for 1/2 to 1 PPD..............14-22mg   1-2 per week.......................21-35mg
for 1 to 2PPD..................22-44mg   2-3 per week.......................35-42mg

Patch delivers 0.9mg/hr of nicotine...reaches daily peak approx 6 hrs
If use more than 1 patch a day, put on at different times of the day

Studies have shown better quit rates with combined therapy. Possible options include:

For some you may consider:
 2 or 4mg gum or lozenge plus a nicotine patch
The gum or lozenge gives a jump start + the patch
Use the gum or lozenge for 2-4 wks...then patch only & gum or lozenge for back up as needed

Can use: Zyban alone or Zyban plus a patch

For those where handling is important: Nicotine inhaler plus a patch

For highly dependent or where other comb. have not worked: Nicotine nasal spray plus a patch

Addictive potential: 5-20% of nicotine gum users continues use after 1 year or more
43% of nasal spray users continue to use at 1 year
Not a problem with patch, inhaler, or Zyban

Keep in mind compliance: Patch 82%, Gum 38%, Spray 15%, Inhaler 11%

Clinical use CHECK LIST:
     Provide written instructions on proper use and give self help material
     Individualize the dose and duration
     Base the initial dose on smoking rate (or blood cotinine)
     Usual length of therapy is 6-8 weeks
     Return visit or phone calls at 1-2 week intervals
     Adjust dose and determine length of pharmo treatment based on patient response

Pharmaceutical companies have developed support materials for those who purchase products
NicodermCQ & Nicorette= Committed Quitters program
     (call 800#, answer Q's & receive personalized plan & calendar,
     newsletter, tip/strategies brochure)
Zyban= Advantage Plan (1-800-822-6784) call or fill out Q that comes with starter kit

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