Nicotine

(NIK-oh-TEEN)

  Action:
Reduces nicotine withdrawal symptoms by providing nicotine levels lower than those associated with smoking.

  Indications:
Aid to smoking cessation. Part of comprehensive behavioral smoking-cessation program.

  Contraindications:
Nonsmokers; during immediate post-MI period; life-threatening arrhythmias; severe or worsening angina pectoris; active temporomandibular joint disease (nicotine
Polacrilex [gum]).

  Route/Dosage:
Advise patient to stop smoking completely when beginning to use smoking cessation therapy.

Nicotine Gum

Adults:
PO If patient smokes < 25 cigarettes/day, chew 2 mg gum (max 24 pieces/day) for up to 12 wk. If patient smokes 25 cigarettes/day, chew 4 mg gum (max 24 pieces/day) for up to 12 wk.

Nicotine Inhaler

Adults:
Inhaler 6 to 16 cartridges/day for up to 6 mo.

Nicotine Transdermal Patches

Adults:
Topical (
Habitrol) If patient smokes 10 cigarettes/day, start with 21 mg/day for first 4 wk, then decrease dose to 14 mg/day for next 2 wk, then decrease dose to 7 mg/day for last 2 wk. If patient smokes < 10 cigarettes/day, start with 14 mg/day for 6 wk then decrease dose to 7 mg/day for last 2 wk. (
Nicoderm) If patient smokes 10 cigarettes/day, start with 21 mg/day for first 6 wk then decrease dose to 14 mg/day for next 2 wk, then decrease dose to 7 mg/day for last 2 wk. If patient smokes < 10 cigarettes/day, start with 14 mg/day for 6 wk then decrease dose to 7 mg/day for last 2 wk. (
Nicotrol ) Use 15 mg/16 hr for 6 wk.

Nicotine Nasal Spray

Adults:
Spray (Each actuation delivers 50 mcL spray containing 0.5 mg nicotine.) 8 to 40 doses/day for 3 to 6 months.

  Interactions:

Acetaminophen, caffeine, imipramine, oxazepam, pentazocine, propanolol, theophylline: Smoking tends to increase metabolism and may lower blood levels of these drugs or others. Smoking cessation, with or without nicotine medication, may reverse these effects.

Food: Effective absorption of nicotine gum depends on mildly alkaline saliva. Coffee, cola, and other drinks or food may reduce salivary pH and should probably be avoided 15 min before and during chewing of gum.

  Lab Test Interferences:
None well documented.

  Adverse Reactions:

CV:

Edema; flushing; hypertension; palpitations; tachyarrhythmias; tachycardia; MI; CHF; cardiac arrest; cerebrovascular accident.

CNS:

Insomnia; dizziness; lightheadedness; irritability; headache; impaired concentration; confusion; convulsions; depression; paresthesia; abnormal dreams.

DERM:

Erythema; rash; itching; urticaria.

EENT:

Buccal cavity irritation; mouth or throat soreness or dryness. With gum chewing: traumatic injury to oral mucosa or teeth; jaw ache; changes in taste perception.

GI:

GI distress; belching; indigestion; nausea; vomiting; excess salivation; hiccoughs; anorexia; constipation; diarrhea.

HEPA:

Alterations of LFTs.

RESP:

Increased cough; pharyngitis; sinusitis; difficulty breathing; hoarseness; sneezing.

OTHER:

Pain; myalgia; arthralgia; dysmenorrhea.

  Precautions:

Pregnancy: Category C (nicotine polacrilex gum); Category D (inhaler, spray, transdermal nicotine).

Lactation: Excreted in breast milk.

Children: Safety and efficacy not established.

Elderly or debilitated patients: May be more susceptible to adverse effects.

Abuse/Dependence: Transference of nicotine dependence from smoking to deterrent product exists. If patient continues to smoke while on nicotine therapy, patient may experience severe effects because of higher nicotine levels.

Cardiovascular effects: Patients with coronary heart disease, serious cardiac arrhythmias, systemic hypertension, or vasospastic disease need to be carefully evaluated and monitored closely because of cardiac effects.

Dental problems: Might be exacerbated by chewing nicotine gum.

Endocrine effects: Use with caution in patients with hyperthyroidism, pheochromocytoma, or insulin-dependent diabetes because of action of nicotine on adrenal medulla.

GI effects: May delay healing in patients with peptic ulcer disease.

Hepatic impairment: May reduce nicotine clearance.

  Administration/Storage:

Transdermal system

• Apply patch promptly on removal from pouch.
• Apply patch once daily to nonhairy, clean, dry skin site on upper body or upper outer arm.
• After patch has been on for 24 hr, remove and apply new patch to alternate skin site. Do not reuse skin sites for 1 wk (exception is
  Nicotrol, which is applied on awakening and removed at bedtime).
• After handling active patch, wash hands with water alone, because soap may increase nicotine absorption. Do not touch eyes.
• After removing used patch from skin, fold over, place in protective pouch, and immediately dispose of it so that it is inaccessible to children and pets.
• Store in cool location. Do not store out of pouch.

Nicotine chewing gum

• Instruct patient to chew gum 1 piece at a time.
• Tell patient to chew intermittently for 30 min. Proper chewing technique is slow-paced chewing and intermittent "parking."
• If gum is chewed fast, increased side effects will result.
• Do not allow patient to eat or drink for 15 min before chewing and during chewing.

Nasal spray

• Administer with the head tilted back slightly.
• Should even a small amount of the spray come in contact with the skin, lips, mouth, eye or eyes, wash the area immediately with water only.
• Store at room temperature.

  Assessment/Interventions:

• Obtain patient history, including drug history and any known allergies.
• Assess for edema, cardiac irregularities or changes, headache, dizziness, inability to sleep, GI distress, or signs of liver dysfunction.
• Assess for history or signs of depression. If present, notify health care provider.
• If patient is diabetic, monitor blood sugar closely.
• Monitor oral mucosa and teeth for traumatic injury related to medicated gum.
• Report cardiac, hepatic, or CNS changes from baseline assessment to health care provider.

  Patient/Family Education:

• Review package insert information with patient.
• Inform patient of serious effects if continuing to smoke while chewing gum or using patch. Instruct patient to stop smoking. Encourage patient to participate in comprehensive smoking cessation program.
• Warn patient of possible dependence of medication.
• Tell patient that gum or patch is not for long-term use and that dose will be gradually tapered off over course of a few weeks to a month.
• Inform patient it will take a few days to adjust to taste of gum.
• Instruct patient to avoid drinking or eating 15 min before and during chewing of gum.
• Advise patient to chew gum slowly 1 piece at a time when urge to start smoking is felt.
• Instruct patient regarding proper use of gum (intermittent technique of slow-paced chewing and "parking").
• Advise patient not to exceed 30 pieces of gum/day (2 mg size) or 20 pieces/day (4 mg size) and to decrease this number gradually over first month.
• Tell patient to inspect mouth daily (if chewing gum) for signs of irritation.
• Instruct patient in proper use and disposal of patch. Tell patient to always remove old patch before applying new one, and to wash hands after applying patch.
• Advise patient regarding proper storage of patch (eg, heat sensitive, rapid evaporation once opened).
• Instruct patient to report the following symptoms to health care provider: GI distress (ie, constipation, diarrhea, nausea), headache, depression, dizziness, hiccoughs, sore throat or pain, or mouth discomfort.

Nasal spray

• Encourage patient to participate in a smoking cessation program.
• If the patient has not stopped smoking by the fourth week of therapy, discontinue treatment.

AtoZ Drug Facts · Copyright©2000 by Facts and Comparisons