The following information is based on the successful use of pharmacological agents in the cessation of smoking in the general population. None of the following agents have been studied in large placebo-controlled studies in cancer patients for aid in smoking cessation. Dosage adjustments or titrations may be required when administering these agents to oncology patients. (Refer to Tables 1 through 7 for more information.)
Nicotine Replacement Therapies
Nicotine replacement therapies are designed to aid in the treatment of withdrawal symptoms associated with nicotine. Several precautions must be considered before therapy is initiated, but these precautions do not constitute absolute contraindications.
- Patients who are pregnant or nursing should obtain advice from a health care professional before using these products.
- Patients should be advised to not use these products if they continue to smoke, chew tobacco, use snuff, or use other nicotine-containing products.
- Patients should be instructed to consult a physician before using these products if they are younger than 18 years, have heart disease or an irregular heartbeat, have high blood pressure not controlled by medication, have a history of or currently have esophagitis or peptic-ulcer disease, use insulin for diabetes, or take prescription medications for depression or asthma.
Table 1. Nicotine Inhalers
Rx = prescription.
|Rx||Nicotrol NS|| ?40 mg/d||Local irritation||Use ?3 months.|
|Rx||Nicotrol Inhaler || Individualized ||Local irritation||Use ?24 weeks.|
Table 2. Nicotine Polacrilex Gums
OTC = over the counter.
|OTC||Nicorette||18-24 mg/d||Sore throat, stomatitis||?30 pieces/d; decrease 1 piece every 4-7 days.|
|OTC||Nicorette DS||36-48 mg/d||Jaw ache||?20 pieces/d; decrease 1 piece every 4-7 days.|
Table 3. Nicotine Lozenges
OTC = over the counter.
|OTC||Commit||40-80 mg/d||Local irritation (warmth and tingling)||Use for 12 weeks; ?20 pieces/d. Weeks 1-6: 1-2 lozenges every 1-2 hours; weeks 7-9: 1 lozenge every 2-4 hours; weeks 10-12: 1 lozenge every 4-8 hours.|
Table 4. Nicotine Patches
OTC = over the counter; Rx = prescription.
|Rx||Habitrol||7-21 mg/d||Erythema||Use for 6-12 weeks.|
|OTC||NicoDerm CQ||7-21 mg/d||Pruritus||Use for 6-12 weeks.|
|OTC||Nicotrol||5-15 mg/d||Burning at site||Use for 14-20 weeks.|
|Rx||ProStep||11-22 mg/d||Local irritation||Use for 6-12 weeks.|
Varenicline is a nicotinic acetylcholine receptor partial agonist and the first U.S. Food and Drug Administration (FDA)-approved prescription pharmacologic agent targeted to these nicotinic receptors.[Level of evidence: I] Although specific mechanisms of action are unknown, it is thought that the agonist properties result in reduced craving and withdrawal by stimulating release of dopamine, and the antagonist properties prevent inhaled nicotine from binding at the nicotinic receptor sites.