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Ross-Flanigan, Nancy
Below:
Definition
Purpose
Description
Recommended Dosage
Precautions
Side effects
Interactions
The nicotine patch is a type of transepidermal patch designed to deliver nicotine, the addictive substance contained in cigarettes, directly through the skin and into the blood stream. The patch contains a drug reservoir sandwiched between a nonpermeable back layer and a permeable adhesive layer that attaches to the skin. The drug leeches slowly out of the reservoir, releasing small amounts of the drug at a constant rate for up to 24 hours.
(Illustration by Electronic Illustrators Group.)
 Definition
Smoking-cessation drugs are medicines that help people stop smoking cigarettes or using other forms of tobacco.
Purpose
People who smoke cigarettes or use other forms of tobacco often have a difficult time when they try to stop. This is partly because they get in the habit of using tobacco at certain times of day or while they are doing certain things, such as having a cup of coffee or reading the newspaper. But the habit is also hard to break because tobacco contains nicotine, a drug that some people find as addictive as cocaine or heroin. A person who is addicted to nicotine has withdrawal symptoms, such as irritability, anxiety , difficulty concentrating and craving for tobacco, when he or she stops using tobacco.
Some people can stop smoking through willpower alone, but most do better if they have support from friends, family, a physician or pharmacist or a formal stop-smoking program. Heavy tobacco users may find that smoking cessation products also help by easing their withdrawal symptoms. Most smoking cessation products contain nicotine, but the nicotine is delivered in small, steady doses spread out over many hours. In contrast, when a person inhales a cigarette, nicotine enters the lungs and then travels to the brain within seconds, delivering the "rush" that smokers come to crave. Another difference is that smoking cessation products do not contain the tar and carbon monoxide that make cigarettes so harmful to people's health.
Description
Smoking cessation drugs that contain nicotine are also called nicotine substitution products or nicotine replacement therapy. These come in four forms--chewing gum, skin patch, nasal spray, and inhaler. Some products are available only with a prescription, but others can be bought over the counter (without a prescription). People who buy the nonprescription products should check with a physician before starting to use them. Some commonly used brands of smoking cessation products are Nicoderm, Nicotrol, Habitrol, ProStep, and Nicorette.
Another type of smoking cessation drug, bupropion (Zyban) also reduces craving and withdrawal symptoms, but it contains no nicotine. The remainder of this entry deals only with smoking cessation drugs that contain nicotine.
Recommended dosage
The recommended dosage depends on the type of smoking cessation drug. Each form of this medicine comes with detailed instructions for its use. Following directions exactly is very important. For example, nicotine gum should not be chewed like regular chewing gum. It must be chewed very slowly until it has a slight taste or causes a slight tingling sensation in the mouth; then "parked" between the cheek and gum until the taste and tingling goes away; then chewed and parked in the same way for about 30 minutes. Nicotine patches and other products also must be used correctly to be effective. Some patches are meant to be worn only during the day and removed at night; others are worn 24 hours a day.
Precautions
Seeing a physician regularly while using smoking cessation drugs is important. The physician will check to make sure the medicine is working as it should and will watch for unwanted side effects.
Do not smoke during treatment with smoking cessation drugs that contain nicotine, as this could lead to nicotine overdose. For the same reason, do not use more than one type of smoking cessation product at a time, and never use more than the recommended amount of medicine. Signs of nicotine overdose include:
Nausea
Vomiting
Severe pain in the stomach or abdomen
Severe diarrhea
Severe dizziness
Fainting
Convulsions (seizures)
Low blood pressure
Fast, weak, or irregular heartbeat
Hearing or vision problems
Severe breathing problems
Severe watering of the mouth or drooling
Cold sweat
Severe headache
Confusion
Severe weakness.
Keep these drugs, including thrown-away patches and gum--out of the reach of children and pets. Even a small amount of nicotine can seriously harm a child or animal.
Nicotine in any form should not be used during pregnancy , as it may harm the fetus or cause miscarriage . Women who may become pregnant should use effective birth control while taking smoking cessation drugs. Women who become pregnant while taking this medicine should stop taking it immediately and check with their physicians.
Nicotine passes into breast milk and may cause problems in nursing babies whose mothers use it. Women who are breastfeeding and want to use smoking cessation drugs may need to stop breastfeeding during treatment.
Anyone who has had unusual reactions to nicotine in the past should let his or her physician know before using a smoking cessation drug. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances. People who have had a rash or irritation from adhesive bandages should check with a physician before using a nicotine patch.
Smoking cessation patches, gum, and other products may make certain medical problems worse. Before using a smoking cessation drug, people with any of these medical problems should make sure their physicians are aware of their conditions:
Heart or blood vessel disease
High blood pressure
Diabetes
Overactive thyroid
Skin rash or irritation
Stomach ulcer
Pheochromocytoma (PCC) (a tumor of the adrenal medulla)
Dental problems or mouth sores
Sore throat
Jaw pain or temporomandibular joint disorder (TMJ).
Side effects
Each type of smoking cessation product may cause minor side effects that usually go away as the body adjusts to the drug. These usually do not need medical attention unless they continue or they interfere with normal activities. For example, nicotine gum may cause belching, jaw aches, or sore mouth or throat. Nicotine patches may cause redness, itching , or burning where the patch is applied. The nasal spray may irritate the nose and sinuses, while the inhaler may cause throat irritation or coughing.
If nicotine gum injures the mouth, teeth, or dental work, check with a physician as soon as possible.
Other side effects are possible. Anyone who has unusual symptoms while using smoking cessation drugs should get in touch with his or her physician.
Interactions
People taking certain drugs may need to change their doses when they stop smoking. Anyone who uses a smoking cessation drug should let the physician know all other medicines he or she is taking and should ask whether the doses need to be changed. Examples of drugs that may be affected when a person stops smoking are:
Insulin
Airway opening drugs ( bronchodilators ) such as aminophylline (Somophyllin), oxtriphylline (Choledyl) or theophylline (Somophyllin-T)
Opioid (narcotic) pain relievers such as propoxyphene (Darvon)
The beta blocker propranolol (Inderal).
Other drugs may also interact with smoking cessation drugs. Be sure to check with a physician or pharmacist before combining smoking cessation drugs with any other prescription or nonprescription (over-the-counter) medicine.
Key Terms
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