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Pharmacological Treatment

    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.

    Table 1. Nicotine Inhalers

    BrandDoseSide EffectsComments
    Rx = prescription.
    RxNicotrol NS≤40 mg/dLocal irritationUse ≤3 months.
    RxNicotrol InhalerIndividualizedLocal irritationUse ≤24 weeks.

    Table 2. Nicotine Polacrilex Gums

    BrandDoseSide EffectsComments
    OTC = over the counter.
    OTCNicorette18–24 mg/dSore throat, stomatitis≤30 pieces/d; decrease 1 piece every 4–7 days.
    OTCNicorette DS36–48 mg/dJaw ache≤20 pieces/d; decrease 1 piece every 4–7 days.

    Table 3. Nicotine Lozenges

    BrandDoseSide EffectsComments
    OTC = over the counter.
    OTCCommit40–80 mg/dLocal 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.

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