Nicotine lozenge

Patients who use the lozenge for smoking cessation should use one lozenge every 1-2 hours for the first 2— weeks, decreasing the interval to every 2-4 hours thereafter. Adverse effects that are common with the nicotine lozenge include heartburn, hiccups, and nausea (Shiffman et al. 2002). Because the product contains phenylalanine, the lozenge should not be used for smoking cessation by individuals with phenylketonuria. 

Schneider NG, Olmstead RE, Steinberg C, et al Efficacy of buspirone in smoking cessation a placebo-controlled trial. Clin Pharmacol Ther 60 568-575, 1996 Shiffman S, Dresler CM, Hajek P, et al Efficacy of a nicotine lozenge for smoking cessation. Arch Intern Med 162 1267-76, 2002... 

Nicotine patch Transdermal Nicotine gum Buccal Nicotine lozenge Buccal Nicotine nasal spray Intranasal 7-22 mg/day (started at 21 mg per day x 2 weeks then 14 mg per day x 2 weeks then 7 mg/day) 20-40 mg/day 2 or 4 mg/piece one piece every 2 hours up to 10 times/day 20-40 mg/day 2-4 mg/lozenge one lozenge every 2 hours, up to 10 times/day 16-32 mg/day 1-2 mg/spray, one in each nostril up to 16 times/day... 

F%.1 Venous blood concentrations in nanograms of nicotine per miUimeter of blood as a function of time for various nicotine delivery systems. Data on the cigarette delivering about 1 mg nicotine (filled square), oral snuff delivering 3.6 mg (filled circle), and 4 mg nicotine gum (star) are from those published by Benowitz et al. (1988). Data on 1 mg nicotine nasal spray (filled triangle) are from Schneider et al. (1996). Data on 21 mg transdermal nicotine patch (open square) are from Benowitz (1993). Data on the 4 mg nicotine lozenge (open circle) are from Choi et al. (2003)... 

Houtsmuller EJ, Henningfleld JE, Stitzer ML (2003) Subjective effects of the nicotine lozenge assessment of abuse liability. Psychopharmacology 167 20-27 Hughes JR, Hatsukami D (1986) Signs and symptoms of tobacco withdrawal. Arch Gen Psychiatr... 

Shiffman, S., et al. 2002. Efficacy of a nicotine lozenge for smoking cessation. Arch Intern Med 162 1267. 

F. Nicotine lozenges contain 2—4 mg nicotine, and ingestion could cause serious toxicity in a child. 

Provide nicotine replacement patch, nasal spray or mouth inhaler, gum, or lozenge. 

Choi JH, Dresler CM, Norton MR, Strahs KR (2003) Pharmacokinetics of a nicotine polacrilex lozenge. Nicotine Tob Res 5(5) 635-644... 

Currently approved NRT products include the transdermal nicotine patch and several acute NRT products, including nicotine gum, lozenge, sublingual tablet, vapor inhaler, and nasal spray. The single-dose nicotine plasma curves for transdermal patch, gum, nasal spray, lozenge, as well oral snuff and a cigarette, are illustrated in Fig. 1 (note for the sake of simphcity, the curve for sublingual tablet is not illustrated, but because of the route of nicotine delivery, the plasma curve is qualitatively similar to nicotine gum). 

A small sublingual nicotine tablet has been developed and is currently being marketed in many European countries, but is not yet available in the USA. The product is designed to be held under the tongue, where the nicotine is absorbed sublingually over about 30 min. The product that is currently available contains 2 mg nicotine, of which 1 mg is absorbed via the buccal mucosa. Compared to the gum and lozenge, the sublingual tablet demands even less activity from the user. The levels of nicotine obtained by use of the 2-mg tablet and 2-mg nicotine gum are similar (Molander and Lunell 2001). 

As shown in Fig. 1, the speed of nicotine uptake in venous blood following several forms of nicotine delivery varies widely, from that of the very slow pattern of nicotine appearance in the blood (several hours to peak level) produced by current transdermal nicotine medications to the explosive rise produced by tobacco smoke inhalation. Nicotine gum, lozenge, tablet, and vapor inhaler can provide more rapid delivery of nicotine than the patch, but the speed and amount obtained are constrained by use patterns. Smokeless tobacco products deliver their nicotine more rapidly than nicotine gum and with less physical effort, but are still slower than cigarettes in their nicotine dehvery. 

Nicotine is available for nicotine addicted subjects as gums, dermal patches, lozenges and nasal sprays to help people quit smoking. All these formulations appear to be equally efficacious, approximately doubling the quit rate compared with placebo. However the abstinence rate at one year is often still not higher than 5%. Administration as a... 

Nicotine polacrilex lozenge, dosage varies consult product labeling Commit, various generic ... 

Nicotine replacement in the form of patches, gum, lozenges, inhalers, and sprays is a way of tapering off the amount of nicotine... 

---