Smokeless Tobacco Lesions Medication

  • Author: Carol E Cheng; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 5, 2010
 

Medication Summary

Both the nicotine patch (in variable doses) and bupropion are helpful in treating nicotine dependence, with an additive effect when used in combination. Other medications useful in treating nicotine dependence include nicotine nasal spray inhalers; nicotine gum; nicotine lozenges; and nontobacco snuff products containing mint, clover, alfalfa, and flavorings.[26] In addition, varenicline was approved by the US Food and Drug Administration in 2006 to help cigarette smokers quit. It also may help users of smokeless tobacco quit by decreasing their withdrawal symptoms.

A case published in the Journal of the American Medical Association was the first to document the efficacy of bupropion for the treatment of smokeless tobacco addiction.[27] A 31-year-old man, with a history of a 1 can/d use of smokeless tobacco for 11 years, had previously attempted to quit using nicotine patches and abrupt cessation. He underwent a 4-week course in behavior modification including coping strategies and maintenance skills and set a quit date. Bupropion (150 mg bid) was started 1 week prior to group therapy and was continued for 10 weeks total. After 1 week, his cravings were reduced, and at 5 weeks, he was tobacco free. The patient remained tobacco free at 8 months.

One 2010 case study noted the success of varenicline (beta-2 neuronal nicotinic acetylcholinergic receptor partial agonist) in cessation of smokeless tobacco initially started at 0.5 mg/d and increased to 1 mg twice daily, used for 24 weeks. Follow-up at 9 months noted the patient remained abstinent from tobacco use. Varenicline was approved in 2006 for smoking cessation.[28]

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Smoking deterrents

Class Summary

These agents are used to aid in smoking cessation, while the patient participates in a behavioral modification program under medical supervision.

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Nicotine transdermal system (Nicotrol)

 

Works best when used in conjunction with a support program, such as counseling, group therapy, or behavioral therapy.

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Nicotine polacrilex nasal spray (Nicotrol NS)

 

Intranasal nicotine may closely approximate the time course of plasma nicotine levels observed after cigarette smoking.

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Nicotine transdermal system 21-mg patch (NicoDerm CQ, Habitrol)

 

Works best when used in conjunction with a support program, such as counseling, group therapy, or behavioral therapy.

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Nicotine polacrilex (Nicorette)

 

The nicotine is absorbed through the oral mucosa. Quickly absorbed and closely approximates time-course of plasma nicotine levels after cigarette smoking.

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Bupropion (Zyban, Wellbutrin)

 

Used in conjunction with a support group and/or behavioral counseling. Inhibits neuronal dopamine reuptake. Also a weak blocker of serotonin and norepinephrine reuptake.

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Varenicline (Chantix)

 

Partial agonist selective for alpha4, beta2 nicotinic acetylcholine receptors. Action is thought to result from activity at a nicotinic receptor subtype, where its binding produces agonist activity while simultaneously preventing nicotine binding. Agonistic activity is significantly lower than nicotine. Also elicits moderate affinity for 5-HT3 receptors. Maximum plasma concentrations occur within 3-4 h after oral administration. Following regular dosing, steady state reached within 4 d.

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Contributor Information and Disclosures
Author

Carol E Cheng  Boston University School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Maryanne Makredes, MD  Resident Physician, Division of Dermatology, University of Massachusetts Medical Center

Maryanne Makredes, MD, is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Alexa F Boer Kimball, MD, MPH  Associate Professor of Dermatology, Harvard University School of Medicine; Vice Chair, Department of Dermatology, Massachusetts General Hospital; Director of Clinical Unit for Research Trials in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital

Alexa F Boer Kimball, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Jacek C Szepietowski, MD, PhD  Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Stiefel GSK Company Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting; Abbott Consulting fee Consulting

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS  Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  30. Katz SI, Wolff K. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1998:1309-14.

 
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