Names and pronunciation
Nicotrol NS Nicoderm , Nicoderm CQ, Habitrol
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Drug reference
Nicotrol NS Nicoderm , Nicoderm CQ, Habitrol
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Func. class.: Smoking deterrent
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Chem. class.: Ganglionic cholinergic agonist
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ACTION: Agonist at nicotinic receptors in peripheral, central nervous systems; acts at sympathetic ganglia, on chemore- ceptors of aorta, carotid bodies; also affects adrenalin-releasing catecholamines
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USES: Deter cigarette smoking
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CONTRAINDICATIONS: Preg- nancy (transdermal, inhaler); hypersen- sitivity, immediate post-MI recovery period, severe angina pectoris Precautions: Pregnancy (gum); breast- feeding, vasospastic disease, dysrhythmias, diabetes mellitus, hyperthyroidism, pheo- chromocytoma, esophagitis, peptic ulcer, coronary/renal/hepatic disease; MRI (patch); soy hypersensitivity (mint lozenge)
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SIDE EFFECTS CNS: Dizziness, vertigo, insomnia, head- ache, confusion, seizures, numbness, tin- nitus, strange dreams CV: Dysrhythmias, tachycardia, palpita- tions, edema, flushing, hypertension EENT: Jaw ache, irritation in buccal cavity GI: Nausea, vomiting, anorexia, indi- gestion, diarrhea, abdominal pain, con- stipation, eructation, irritation RESP: Breathing difficulty, cough, hoarseness, sneezing, wheezing, bron- chial spasm
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INTERACTIONS Increase: vasoconstriction—ergots, bro- mocriptine, cabergoline Increase: effect after smoking cessation— adrenergic antagonists, β blockers Increase: effect of—adenosine Increase: B/P—buPROPion Decrease: effect of—α-blockers, insulin Decrease: nicotine clearance—cimetidine Drug/Food • Avoid use of gum with acidic foods (colas, coffee) and for 15 min after
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DOSAGE AND ROUTES Nicotine chewing gum • Adult: chew 1 piece of gum (2 mg nico- tine) whenever urge to smoke occurs; dose varies; usually 20 mg/day during first mo, max 24 pieces/day, max 3 mo Nicotine inhaler • Adult: INH 6 cartridges/day (24-64 mg) for up to 12 wk, then gradual reduc- tion over 12 wk Nicotine lozenge • Adult: if cigarette is desired >30 min after awakening, start with 2-mg lozenge; if <30 min after awakening, start with 4-mg lozenge, then again q1-2hr, max 20 lozenges/day or 5 lozenges/6 hr × 6 wk, then 1 lozenge q2-4hr × 2 wk, then 1 lozenge q4-8hr × 2 wk, then discontinue Nicotine nasal spray • Adult: 1 spray in each nostril 1-2×/hr, max 5×/hr or 40×/day, max 3 mo Nicotine transdermal/inhaler system • Nicoderm: 21 mg/day × 4-8 wk; 14 mg/day × 2-4 wk; 7 mg/day × 2-4 wk • Nicotrol: 15 mg/day × 12 wk; 10 mg/ day × 2 wk; 5 mg/day × 2 wk • Nicotrol inhaler: delivers 30% of nico- tine that smoker receives from an actual cigarette
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Available forms: Transdermal patch (Habitrol , Nicoderm, nicotine trans- dermal system) delivering 7, 14, 21 mg/ day; (Nicoderm) 5, 10, 15 mg/day; nico- tine inhaler 4 mg delivered; nasal spray 0.5 mg nicotine/actuation; gum 2, 4 mg/piece; lozenge 2 mg, 4 mg
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Administer: • Gum: chew gum slowly for 30 min to promote buccal absorption of product; do not chew >45 min • Do not expose to light; gum will turn color • Begin product withdrawal after 3 mo of use; do not exceed 6 mo • Transdermal patch: 1× day to non- hairy, clean, dry area of skin on upper body or upper outer arm; rotate sites to prevent skin irritation; can remove before bed if patient has strange dreams • Nasal spray/inhaler: puffing on mouth- piece delivers nicotine through mouth • Lozenge: allow to dissolve slowly
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Assess: • Smoking: number of cigarettes smoked, years used, brand; withdrawal: N headache, cravings, restlessness, irrita- tion, drowsiness, insomnia, sore throat, periodic increase in appetite • Adverse reaction: irritation of buccal cavity, dislike of taste, jaw ache, gum should not be used if temporomandibu- lar condition exists • Toxicity: nausea, vomiting, diarrhea, headache, dizziness, dyspnea, hypertension • Pregnancy/breastfeeding: whenever possible, avoid in pregnancy; cautious use in breastfeeding
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Evaluate: • Therapeutic response: decrease in urge to smoke, decreased need for gum after 3-6 mo
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To discontinue if patient is unable to stop smoking after 4th week of therapy • Gum: about all aspects of product use; give package insert to patient and explain • That gum will not stick to dentures, dental appliances • That gum is as toxic as cigarettes; that it is to be used only to deter smoking; to call prescriber immediately, stop use if difficulty breathing or rash occurs • To avoid use during pregnancy • Transdermal patch: that patch is as toxic as cigarettes; to be used only to deter smoking • Not to use during pregnancy because birth defects may occur; not to breastfeed • To keep used and unused system out of reach of children and pets • To stop smoking immediately when beginning patch treatment • To apply promptly after removing from protective patch because system may lose strength • Nasal spray: to tilt head back; not to swallow or inhale during administration; after smoking is stopped, to use spray up to 8 wk, then discontinue over 6 wk by tapering • Lozenges: to allow to dissolve; to avoid swallowing; not to chew • Inhalation: to use by inhaler for 20 min by frequent puffs
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PHARMACOKINETICS Onset 15-30 min, metabolized in liver, excreted in urine, half-life 2-3 hr, 30-120 hr (terminal)
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• Adult: chew 1 piece of gum (2 mg nico- tine) whenever urge to smoke occurs; dose varies; usually 20 mg/day during first mo, max 24 pieces/day, max 3 mo Nicotine inhaler
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• Adult: INH 6 cartridges/day (24-64 mg) for up to 12 wk, then gradual reduc- tion over 12 wk Nicotine lozenge
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• Adult: if cigarette is desired >30 min after awakening, start with 2-mg lozenge; if <30 min after awakening, start with 4-mg lozenge, then again q1-2hr, max 20 lozenges/day or 5 lozenges/6 hr × 6 wk, then 1 lozenge q2-4hr × 2 wk, then 1 lozenge q4-8hr × 2 wk, then discontinue Nicotine nasal spray
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• Adult: 1 spray in each nostril 1-2×/hr, max 5×/hr or 40×/day, max 3 mo Nicotine transdermal/inhaler system
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• Nicoderm: 21 mg/day × 4-8 wk; 14 mg/day × 2-4 wk; 7 mg/day × 2-4 wk
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• Nicotrol: 15 mg/day × 12 wk; 10 mg/ day × 2 wk; 5 mg/day × 2 wk
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• Nicotrol inhaler: delivers 30% of nico- tine that smoker receives from an actual cigarette
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