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    Smoking in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - 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 Table 1 through Table 6 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

    Brand Dose Side Effects Comments
    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

    Brand Dose Side Effects Comments
    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

    Brand Dose Side Effects Comments
    OTC = over the counter.
    OTC Commit 40-80 mg/d Local irritation (warmth and tingling) Use for 12 weeks; ≤20 lozenges/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

    Brand Dose Side Effects Comments
    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.
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