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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.

Table 4. Nicotine Patches

BrandDoseSide EffectsComments
OTC = over the counter; Rx = prescription.
RxHabitrol7–21 mg/dErythemaUse for 6–12 weeks.
OTCNicoDerm CQ7–21 mg/dPruritusUse for 6–12 weeks.
OTCNicotrol5–15 mg/dBurning at siteUse for 14–20 weeks.
RxProStep11–22 mg/dLocal irritationUse for 6–12 weeks.

Varenicline (Chantix)

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.[2][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.[3]

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