Nicotine Replacement Therapy: Administration and Overview

Barbara Hart, MPA and Claudia Lechuga, MS Bronx BREATHES T: (718)430-2601 E: [email protected] / [email protected]

www.bronxbreathes.org

June 15, 2009

Smoker Assessment

• • • • History of usage Previous quit attempts – Withdrawal/abstinence symptoms Motivational level for quit attempt Current social environment – – Stressors Triggers – – Biological/medical assessment Family and friend support/sabotage

Previous Quit Attempts

• • • • • • • Dates Age Method used to quit – Medications or counseling used (if any) Duration of that method Problems and successes experienced Reason for relapse Withdrawal/Abstinence Symptoms

Current Quit Attempt

• • • Motivational Level – Confidence Main reason for considering/wanting to stop Concerns about quitting – Weight gain concerns

Use of NRT

• • •

Reasons for using NRT

Doubles the success rate Treats nicotine withdrawal – Helps patient feel more comfortable Safe – Patient receiving same drug (nicotine) in a less addictive form over a relatively short period • • • •

Reasons for NOT using NRT

Medical conditions requiring caution/physician input – i.e. recent MI, pregnancy, current arrythmia Age – Under 18s require physician/parental input Specific issues – – Allergy to patches Personal aversion to medication Questionable efficacy – i.e. those smoking less than 10pd

Tobacco Cessation Medications

• • • • •

Nicotine Replacement

Patch * Gum * Lozenge * Oral Inhaler ^ Nasal Spray ^ • •

Non-nicotine medication

Bupropion ^ – (Zyban/Wellburtrin) Varenicline ^ – (Chantix) * Available OTC ^ prescription only

Nicotine Delivery Comparison

Nicotine Delivery Device

Marlboro Red 13 mg

Approx Amount of Nicotine in Nicotine Delivered to Product User Tobacco Products

1-3 mg Marlboro Light Cigars 13 mg 10-40 mg 1-3 mg Highly Variable Moist Snuff Nicotine Gum Nicotine Gum Nicotrol Patch (Pharmacia) Nicoderm CQ Step 3 (Glaxo Smith Kline) Nicoderm CQ Step 2 (Glaxo Smith Kline) Nicoderm CQ Step 1 (Glaxo Smith Kline) Varies depending on pH and 3-12 mg

Nicotine Replacement Products

2 mg piece Up to 0.8 mg 4 mg piece other characteristics Up to 1.5 mg 15 mg / 16 hours 7 mg / 24 hours 14 mg / 24 hours 21 mg / 24 hours

Comments

Also delivers a wide range of carcinogens and other toxins Only delivers nicotine to the consumer

Medication Overview

Product

Nicotine Patch

Use

Apply each day to clean, dry, hairless skin. Start 21 mg patch if .10 cig per day; can taper to 14 mg in 4-6 weeks, then 7 mg in 2 weeks if no cravings Nicotine Gum Chew every 1-2 hours as needed; chew and park; 2 and 4 mg strength (4mg if around 1 ppd)

Advantages

Place and forget; over the counter; can decrease morning cravings if worn at night

Disadvantages

Passive - no actions to take when craving occurs

Precautions

Not recommended to use while smoking; caution within 6 weeks of heart attack Use as needed; can self-dose; Over the counter Difficult to chew Avoid food and acidic drinks 15 minutes before and while using (decreases absorption)

Side Effects

Skin reaction (50% of patients; usually mild and can use hydrocortisone cream); Rotate sites; vivid dreams or sleep disturbances possible at night Jaw pain; nausea if swallowing saliva

Cost

$45/2 week supply (generics available and effective) $35-50/2 week supply

• •

Use and Efficacy of combination therapy

Multiple patch therapy (42 vs 21mg) – 20% increased abstinence – – No significant increased sleep disturbances (Dale 1995; Jorenby 1995)

Patch + Gum

– Kornitzer 1995; Puska 1995 • Early better rates – 7% increase at 6 months • Not sustained at 1 year • No increase in adverse events – 2008 OHS Guidelines Meta-analysis • Path + Gum/Spray OR = 1.9

– Compared to patch alone (OR=1) – Fiore 2008 • Abstinence rates – Nicotine Patch = 23.4% – Nicotine Gum = 19.0% – Long term Patch + Gum = 36.5%

Important Points about NRT

• Nicotine is the addictive part of tobacco smoke but NOT the most dangerous part • People do NOT generally become addicted to medication • People DON’T use enough medication or stop TOO EARLY – Medications are SAFE and EFFECTIVE – Plan on minimum of 2 months of medication • Combinations – Work better than single medications • Use Long acting + Short acting

NRT Kits Available

• •

Moderate Smokers

Smoke 10-20 per day Includes: – Novartis Step 1 • 28 count 21 mg patches • •

Heavy Smokers

Smoke 20+ per day Includes – – : Nicorelief Gum • 110 pieces of 4mg gum Novartis Step 1 • 28 count of 21mg patches

NRT Enrollment Forms

 Necessary for each course distributed  Full information required  Fax or email back to Bronx BREATHES

NRT Enrollment Forms

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NRT Enrollment Forms

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NRT Enrollment Forms

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