Nicotine Addiction Medication

  • Author: R Gregory Lande, DO, FACN; Chief Editor: Eduardo Dunayevich, MD   more...
 
Updated: May 10, 2012
 

Medication Summary

Two types of medications are available as part of a smoking cessation program. Types include nicotine replacement therapy in the form of cutaneous patches, inhaled or nasal delivery, or chewing gum and the non–nicotine-containing tablet bupropion. These medications ameliorate withdrawal symptoms while the smoker deals with behavioral aspects of smoking cessation.

Nicotine chewing gum, if chewed correctly, increases quit rates up to 2-fold. At 1 year, the abstinence rate with the patch is 20%. At 4 years, the abstinence rate is 12.4% compared to 4.5% with placebo.

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Nicotine replacement therapy (patches)

Class Summary

Nicotine patches are sold under the following trade names: NicoDerm, Nicotrol, and Habitrol. The dosing schedule of each is a graduated decrease of drug over 9-12 wk.

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Nicotine transdermal system (NicoDerm CQ)

 

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

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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 transdermal (Habitrol)

 

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

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Nicotine replacement therapy (chewing pieces)

Class Summary

These are marketed in 2 strengths (2 mg and 4 mg). An individual who smokes 1 pack per day should use 4-mg pieces. The 2-mg pieces are to be used by individuals who smoke less than 1 pack per day. Instruct the patient to chew hourly and for their initial cravings for 2 wk, then gradually reduce amount chewed over the next 3 mo.

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Nicotine polacrilex (Nicorette)

 

Comes in boxes containing 96 pieces and costs approximately US $20-30. The nicotine is absorbed through the oral mucosa. Quickly absorbed and closely approximates time course of plasma nicotine levels observed after cigarette smoking.

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Nicotine replacement therapy (nasal spray)

Class Summary

Provides nicotine delivery through nasal mucosa

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Nicotine polacrilex nasal spray (Nicotrol NS)

 

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

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Nicotine replacement therapy (inhaler)

Class Summary

Delivers nicotine through oral mucosa.

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Nicotine polacrilex inhaler (Nicotrol Inhaler)

 

Quickly absorbed and closely approximates time course of plasma nicotine levels observed after cigarette smoking.

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Antidepressants

Class Summary

The drug bupropion is used as a non–nicotine-containing aid to smoking cessation. Acts by enhancing the central nervous nonadrenergic function. A recent study demonstrated a 23% sustained cessation rate with bupropion tablets at 1 year, compared to a 12% sustained cessation rate with placebo. Bupropion also is effective for patients in whom nicotine replacement therapy fails.

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Bupropion hydrochloride (Zyban)

 

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

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Nicotinic acetylcholine receptor partial agonists

Class Summary

Bind to nicotine receptors and elicit mild nicotine central effects to ease withdrawal symptoms. Also decrease stimulatory effect from consuming nicotine products by blocking nicotine receptors.

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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

R Gregory Lande, DO, FACN  Clinical Consultant, Army Substance Abuse Program, Department of Psychiatry, Walter Reed Army Medical Center

R Gregory Lande, DO, FACN is a member of the following medical societies: American Osteopathic Academy of Addiction Medicine and American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Sarah C Aronson, MD  Associate Professor, Departments of Psychiatry and Medicine, Case Western Reserve School of Medicine/University Hospitals of Cleveland

Sarah C Aronson, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Sunovion Honoraria Speaking and teaching; Otsuke Grant/research funds reseach; Merck Honoraria Speaking and teaching

Chief Editor

Eduardo Dunayevich, MD  Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati College of Medicine; Clinical Research Physician, Neuroscience, Lilly Research Laboratories

Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Sat Sharma, MD, FRCPC, and Morley Lertzman, MD, FRCP(C), to the development and writing of this article.

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