Nicorette

Tobacco dependence by relieving nicotine craving & w/drawal symptoms in connection w/ smoking cessation in smokers motivated to quit. May be used to abruptly stop smoking in smokers motivated to quit (smoking cessation); cut down smoking before completely stopping (reduction to stop) or assist during times when unwilling or unable to smoke (temporary abstinence).

Individualized dosage. Highly dependent smokers (≥20 cigarettes daily or 1st cigarette in the morning ≤30 min after waking up) Initially 4 mg. Other smokers Initially 2 mg. Highly dependent smokers, smokers who experience breakthrough cravings or those who failed w/ single nicotine replacement therapy (NRT) treatment Flexible smoking cessation format, in combination w/ patch for fast relief of cravings. Do not exceed 30 gums (2 mg) & 24 gums (4 mg) in 24-hr period. Smoking cessation Monotherapy: 8-12 gums/day. Max: 30 gums (2 mg) & 24 gums (4 mg) in 24-hr period for at least 3 mth. Smokers should stop smoking completely during the course of treatment w/ medicated chewing gum. Initiate gradual tapering from gum & stop treatment when dose is reduced to 1-2 gum/day. Combination therapy: Same dosing recommendation for both patch & flexible format as in monotherapy. Smokers should stop smoking completely during the course of treatment w/ medicated chewing gum. Start w/ tapering patch as in monotherapy or use flexible format as in monotherapy if further tapering is needed. Reduction to stop Use as needed, between smoking episodes to prolong smoke-free intervals & w/ the intention to reduce smoking as much as possible. After having quit smoking, treatment/tapering recommendations for smoking cessation as previously mentioned should be followed. Temporary abstinence Safer alternative: Up to 30 gums/day (2 mg) or 24 gums/day (4 mg) during smoke-free periods.

Should be taken on an empty stomach: Chew gum slowly for approx 30 min w/ pauses until strong taste or mild burning sensation is experienced, then rest it between the cheek & the gums. When the taste &/or sensation have disappeared, chew it again slowly & repeat.

Hypersensitivity. Do not administer to adolescents <18 yr.

Dependent smokers w/ recent MI, unstable or worsening angina including Prinzmetal's angina, severe cardiac arrhythmias, recent CVA, &/or who suffered w/ uncontrolled HTN should be encouraged to stop smoking w/ non-pharmacological interventions (eg, counselling). Caution in patients w/ phaeochromocytoma & uncontrolled hyperthyroidism; oesophagitis, gastric or peptic ulcers & NRT prep; w/ history of epilepsy or seizures during introduction of NRT. Closely monitor blood sugar levels in patients w/ DM. Transferred dependence. Concomitant use w/ drugs metabolized by CYP1A2; potential clinical importance of products w/ narrow therapeutic window (eg, theophylline, tacrine, clozapine & ropinirole). Chewing gum may stick to, & in rare cases damage dentures. Caution in patients w/ moderate to severe hepatic impairment &/or severe renal impairment. Pregnant smoker should always be advised to stop smoking completely w/o use of NRT. Avoid nicotine during breast feeding. Nicotine doses can produce severe toxicity in childn that may be fatal.

Dysphoria or depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating & restlessness or impatience. Decreased heart rate; increased appetite or wt gain, dizziness or presyncopal symptoms, cough, constipation, gingival bleeding or aphthous ulceration, or nasopharyngitis. Diarrhoea.

May possibly enhance haemodynamic effects of adenosine ie, increase in BP & heart rate & also increased pain response (angina-pectoris type chest pain) provoked by adenosine administration.

Drugs Used in Substance Dependence

N07BA01 - nicotine ; Belongs to the class of drugs used in the management of nicotine dependence.

Non-Rx