Smokeless Tobacco Lesions Medication

Updated: Jun 25, 2018
  • Author: Carol E Cheng, MD; Chief Editor: William D James, MD  more...
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Medication Summary

The US Public Health Service recommends nicotine replacement therapy (NRT) (nicotine patch, gum, lozenge, inhaler, or nasal spray), bupropion sustained release (SR), and varenicline as first-line treatments for tobacco dependence. [49] There may also be 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. [50]  

A 2012 meta-analysis on pharmacologic interventions for treatment of smokeless tobacco use concluded that bupropion and NRT have not demonstrated efficacy for increasing long-term tobacco abstinence rates among smokeless tobacco users. However, bupropion could be used to attenuate postcessation weight gain among smokeless tobacco users trying to become tobacco abstinent, and NRT could be used to increase short-term abstinence rates and to alleviate symptoms of withdrawal. As in cigarette smokers, varenicline seems to be the most effective treatment for smokeless tobacco users attempting to achieve tobacco abstinence. Further research is needed to evaluate high-dose NRT and combination therapy for smokeless tobacco users. [51]

Counseling and medication are effective when used by themselves for treating tobacco dependence. The combination of counseling and medication, however, is more effective than either alone. Thus, clinicians should encourage all individuals making a quit attempt to use both counseling and medication. [49]


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.

Nicotine transdermal system (Nicotrol)

A nicotine transdermal system works best when used in conjunction with a support program, such as counseling, group therapy, or behavioral therapy.

Nicotine polacrilex nasal spray (Nicotrol NS)

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

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

The nicotine transdermal system 21-mg patch works best when used in conjunction with a support program, such as counseling, group therapy, or behavioral therapy.

Nicotine polacrilex (Nicorette)

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

Bupropion (Zyban, Wellbutrin)

Bupropion is used in conjunction with a support group and/or behavioral counseling. It inhibits neuronal dopamine reuptake. It is also a weak blocker of serotonin and norepinephrine reuptake.

Varenicline (Chantix)

Varenicline is a 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. The agonistic activity is significantly lower than nicotine. It also elicits moderate affinity for 5-HT3 receptors. Maximum plasma concentrations occur within 3-4 hours after oral administration. Following regular dosing, a steady state is reached within 4 days.