Smoking-Cessation Drugs Health Article

Recommended dosage

The recommended dosage of nicotine replacement products depends on the method of administration. 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.

Smokers who are heavily dependent on nicotine may want to ask their doctors about using a combination of nicotine replacement products. Studies done between 1995 and 2000 indicate that combining the transdermal patch with either the gum or the nasal spray helps more smokers quit than any of the three products by themselves. It is thought that the higher success rate is due to the different rates of speed at which these products deliver nicotine to the body. The nasal spray delivers nicotine very rapidly, and can be used to relieve intense cravings at times of the day when the smoker is accustomed to having a cigarette, while the patch delivers a smaller dosage of nicotine to the body at a steadier rate.

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.

Nicotine by itself is a poisonous substance. Do not smoke during treatment with smoking cessation drugs that contain nicotine, as the combination 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 for nursing babies. 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)

There are also precautions to take with bupropion and buspirone. Bupropion should not be taken by patients with a history of seizures, high blood pressure, anorexia, or bulimia nervosa. People taking buspirone should be careful about driving or operating heavy machinery until they can tell whether the drug makes them drowsy as a side effect. Although buspirone does not interact with alcohol as intensely as most tranquilizers do, patients should still use alcohol cautiously if they are taking buspirone.