Table 2. First Line Pharmacotherapies for Smoking Cessation
Pharmaceutical
Directions
Precaution/Contraindications
Side Effects

Bupropion (generic name)

Zyban (Trade Name) 150 mg
Dispense: 7-12 week supply
Begin 1-2 weeks before quit date; 150 mg each morning for 3 days, then increase to 150 mg twice daily.

Available only by prescription.
Maintenance for up to 5 months.
Caution patients not to take the second dose after approxi-mately 6:00 pm, as it may interfere with sleep. 		Seizure history
History of eating disorder
Heavy alcohol use
Monoamine Oxidase Inhibitor (MAOI) use		 Insomnia
Dry mouth

Nicotine Gum

Nicorette Gum (Plain, Mint or Orange Flavor) 2 or 4 mg pieces
Dispense: 12 week supply
Chew the gum slowly until it tingles. Then park it between your cheek and gum. When the tingle is gone, begin chewing again, until the tingle returns. Repeat this process until most of the tingle is gone (about 30 minutes). Do not eat or drink for 15 minutes before chewing the nicotine gum or while chewing a piece of gum. Use at least 9 pieces per day for the first 6 weeks. Do not exceed 24 pieces per day.

 Available over the counter (OTC)
Use 2 mg pieces if the patient smokes less than 25 cigarettes per day
Use 4mg pieces if the patient smokes more than 25 cigarettes per day.
Treat for 12 weeks, gradually begin taper at 7 weeks.		 Severe Cardiovascular disease;
Compromised chewing ability;
Temporomandibular disorders		 Dyspepsia
Mouth soreness
Hiccups

Nicotine Inhaler

Nicotrol Inhaler
Dispense: 12 week supply
Use at least 6 cartridges per day at least for the first 3-6 weeks of treatment. Additional doses may be needed to control the urge to smoke with a maximum of 16 cartridges daily for up to 12 weeks.

 Available by prescription only;
Treat for 12 weeks with a gradual taper for an additional 12 weeks;
Regular use during the first week of treatment may help patients adapt to the mouth or throat irritation 		Severe cardiovascular disease;
Severe reactive airway disease		 Mouth or throat irritation

Nicotine Nasal Spray (generic name)

Nicotrol Nasal Spray (Trade Name)

Dispense: 12 week supply
Administer the spray with the head tilted back slightly. One dose is 1 mg of nicotine (2 sprays, one in each nostril). Begin with 1 or 2 doses per hour. Use at least 8 doses per day up to a maximum recommended dose of 40 mg (80 sprays, somewhat less than ½ bottle) per day

 Available by prescription only;
Treat for 8 weeks following which use of the spray should be discontinued over the next 4-6 weeks. Some patients may not require gradual taper of dosage and may abruptly stop treatment.
Do not treat past 5 months. 		Severe cardiovascular disease; severe reactive airway disease Nasal irritation

Nicotine Patch (Generic Name)

Nicoderm CQ/Generic

21/14/7 mg Patches
Dispense: 8 week supply
Begin with the most potent strength 21 mg for 4 weeks, followed by the 14 mg patch for 2 weeks and the 7 mg patch for 2 weeks. Each morning, place one patch on an area of hairless skin above the waist (usually, the arm). Hold for ten seconds then wash hands.


Nicotrol 15 mg Patch
Dispense: 6 week supply
Apply one 15 mg patch per day.

Available over the counter (OTC) and by prescription.
Treat for 8 weeks with tapering patch dose.

 

 

 

 

Available OTC; there is no taper; discontinue after 6 weeks.

Severe cardiovascular disease

 Local skin irritation;
insomnia