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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 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.[1]

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 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.
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