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NERVOUS SYSTEM › OTHER NERVOUS SYSTEM DRUGS › DRUGS USED IN ADDICTIVE DISORDERS › Drugs used in nicotine dependence
nicotine
N07BA01
Forms & Strengths
- Transdermal patch: 7 mg/24 hr, 14 mg/24 hr, 21 mg/24 hr; 10 mg/16 hr, 15 mg/16 hr
- Chewing gum: 2 mg, 4 mg
- Lozenge: 2 mg, 4 mg
- Inhalation cartridge: 10 mg (delivers 4 mg)
- Nasal spray: 10 mg/mL (0.5 mg/spray)
Adult Dosing
- Patch (>10 cig/day): 21 mg/24 hr daily for 6 weeks, then 14 mg/24 hr for 2 weeks, then 7 mg/24 hr for 2 weeks
- Gum/Lozenge: 1 piece every 1-2 hours as needed for cravings; max 24 pieces/day (gum) or 20 pieces/day (lozenge)
- Inhaler: 6-16 cartridges/day as needed for up to 12 weeks
- Nasal spray: 1-2 sprays per hour (one spray in each nostril); max 40 sprays/day
Pediatric Dosing
- Safety and efficacy not established in pediatric patients under 18 years of age
- Smoking cessation in adolescents (12-17 years): Off-label, behavioral therapy is primary; pharmacotherapy used only in severe dependence under specialist supervision
Indications
- Nicotine replacement therapy (NRT) for smoking cessation to relieve withdrawal symptoms
- Reduction of cigarette consumption in smokers unable or not ready to quit abruptly
Mechanism of Action
- Agonist at nicotinic acetylcholine receptors in the central and peripheral nervous systems
- Stimulates release of dopamine, norepinephrine, serotonin, acetylcholine, GABA, and beta-endorphins, reducing withdrawal symptoms and craving
Contraindications
- Hypersensitivity to nicotine or any component of the delivery system
- Immediate post-myocardial infarction period
- Severe or worsening angina pectoris
- Life-threatening arrhythmias
Adverse Reactions
- Local skin irritation, erythema, and pruritus (transdermal patch)
- Mouth and throat soreness, jaw ache, hiccups, dyspepsia (gum/lozenge)
- Rhinitis, nasal irritation, watery eyes, sneezing (nasal spray)
- Cough, throat irritation (inhaler)
- Systemic: Insomnia, headache, nausea, dizziness, palpitations
Drug Interactions
- Cessation of smoking induces hepatic enzymes (CYP1A2), potentially increasing serum concentrations of substrates such as caffeine, theophylline, and olanzapine
- Adrenergic agonists and antagonists: Smoking cessation may alter pharmacokinetic and pharmacodynamic responses to beta-blockers and sympathomimetics
Curated Content: Needs Vetting Before Put to Clinical Use