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]

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)

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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)

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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)

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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)

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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)

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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)

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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.

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Media Gallery

Verrucous carcinoma.
Oral leukoplakia.

of 2

Author

Carol E Cheng, MD Assistant Clinical Professor of Dermatology, University of California, Los Angeles, David Geffen 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 Boer Kimball, MD, MPH Professor of Dermatology, Harvard Medical School; Senior Vice President, Service Excellence and Practice Improvement, Massachusetts General Physicians Organization, Vice Chair, Department of Dermatology, Director, Clinical Unit for Research Trials in Skin (CURTIS), Massachusetts General Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio

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

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

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: Received consulting fee from Orfagen for consulting; Received consulting fee from Maruho for consulting; Received consulting fee from Astellas for consulting; Received consulting fee from Abbott for consulting; Received consulting fee from Leo Pharma for consulting; Received consulting fee from Biogenoma for consulting; Received honoraria from Janssen for speaking and teaching; Received honoraria from Medac for speaking and teaching; Received consulting fee from Dignity Sciences for consulting; .

Acknowledgements

Jacqueline Dolev, MD, Assistant Clinical Professor, Director for the Advancement of Medical Education in Dermatology, Department of Dermatology, University of California, San Francisco Medical Center

Disclosure: Nothing to disclose.

Smokeless Tobacco Lesions Medication

Medication Summary

Smoking deterrents