Nicotine

A to Z Drug Facts

(NIK-oh-TEEN)

Habitrol, Nicoderm, Nicorette, Nicorette DS, Nicotrol, Nicotrol NS, Nicotrol Inhaler, ProStep, Nicorette Plus

Class: Smoking deterrent

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

 Route/Dosage

TRANSDERMAL PATCHES

ADULTS: Topical Apply one patch daily. Start with 14 to 22 mg/day patches. Gradually decrease dose by using smaller dose patches over 2 to 5 mo.

NICOTINE NICORETTE (NICOTINE GUM)

ADULTS: PO 4 mg pieces (maximum 20 pieces/day) for highly dependent patients. For others, 2 mg pieces (maximum 30 pieces/day). Chew 1 piece prn or on fixed schedule of 1 piece q 1 to 2 hr initially. Initiate gradual weaning from treatment after 2 to 3 mo and complete withdrawal by 4 to 6 mo.

NICOTINE PUMP SPRAY

ADULTS: Spray One dose is 1 mg (2 sprays, one in each nostril). 1 to 2 doses/hr to a maximum of 5 doses/hr or 40 doses/day. Treatment should last < 3 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 liver function tests. RESP: Increased cough; pharyngitis; sinusitis; difficulty breathing; hoarseness; sneezing. OTHER: Pain; myalgia; arthralgia; dysmenorrhea.

 Precautions

Pregnancy: Category C (nicotine polacrilex); Category D (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. Skin sites should not be reused for ³ 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

• Spray should be administered 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 physician.
• 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 physician.

 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 not to smoke anymore. Encourage patient to participate in comprehensive smoking cessation program.
• Warn patient on 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 few wk to mo.
• 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 mo.
• 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 physician: GI distress (ie, constipation, diarrhea, nausea), headache, depression, dizziness, hiccoughs, sore throat, pain or mouth discomfort.

Nasal Spray

• Encourage the patient to participate in a smoking cessation program.
• If the patient has not stopped smoking by the 4th week of therapy, treatment should probably be discontinued.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts