Nicotine replacement

In general, for smokers with cardiac disease, the benefits of nicotine replacement therapy outweigh the potential risks. In a safety and efficacy study that included veterans with cardiac disease, smoking concurrently with the nicotine patch was not associated with an increase in adverse events (Joseph et al. 1996). Although bupropion SR is generally well tolerated by smokers, it has not been adequately studied in persons with cardiac disease, and definitive conclusions regarding its safety in this patient population cannot currently be made (Society for Research on Nicotine and Tobacco 2003). 

Cigarette smoking induces CYP1A2 increasing the metabolism of clozapine may need to increase usual clozapine dose when a patient begins to smoke, or decrease clozapine dose if smoking is stopped or nicotine replacement is used instead of smoking. 

Symptomatic detoxification from nicotine is achieved with any of the currently available nicotine replacement therapies (NRTs) or a combination thereof.25 Several CNS neurotransmitters... 

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

Hutchison, K, Monti, P., Rohsenow, D. et al. Effects of naltrexone with nicotine replacement on smoking cue reactivity preliminary results. Psychopharmacology. 142 139, 1999. 

Lerman, C.W.E., Patterson, F., Rukstalis, M., Audrain-McGovem, J., Restine, S., Shields, P.G., Kaufmann, V., Redden, D., Benowitz, N., Berrettine, W.H. The functional mu opioid receptor (OPRM1) Asn40Asp variant predicts short-term response to nicotine replacement therapy in a clinical trial. Pharmacogenomics J. 4 184, 2004. 

Accurate prediction of the rate of nicotine metabolism based on CYP2A6/D6 genotype could make adjusting the dose of nicotine replacement to avoid side effects and ensure effectiveness much simpler. It may be that information technology could help in making decisions about the choice [63] and dose [64] of drug based on genetic data. 

Nicotine is responsible for the highly addictive properties of tobacco products. Addiction occurs in 30% of those who experiment with tobacco products, and more than 80% of those who attempt to quit smoking will relapse within a year. Withdrawal from nicotine produces a syndrome characterized by nicotine craving as well as dysphoria, anxiety, irritability, restlessness and increased appetite. It is treated with nicotine replacement therapies, such as nicotine gum and patches, and/or with buproprion, a drug that is classified as an antidepressant but has multiple and complex effects in brain. Buproprion reduces craving in some smokers. Nicotine addiction has been reviewed recently at cellular and systems levels [38-41]. 

Assessment and reduction in the use of alcohol, tobacco, and other substances prior to pregnancy improve outcomes. For smoking cessation, behavioral interventions are preferred. Intermittent delivery formulations of nicotine replacement therapies are preferred over the patches. If patches are used, 16-hour patches are preferred over 24-hour patches. 

Interventions are more effective when they last greater than 10 minutes, involve contact with a professional, provide at least four to seven sessions, and provide nicotine-replacement therapy (NRT). Group and individual counseling is effective, and interventions are more successful when they include social support and training in problem-solving, stress management, and relapse prevention. 

Nicotine polacrilex (gum)0 First-line Initial dose depends on smoking history 2-4 mgevety 1-8 hours 12 weeks (taper down over time) Heart rate and blood pressure should be monitored periodically during nicotine replacement therapy. Al... 

Nicotine replacement therapies can be combined with each other and/or bupropion to increase long-term abstinence rates. bOo not abruptly discontinue. Taper up initially, and taper off once therapy is complete. cClonidine and nortriptyline are not FDA approved for smoking cessation. 

Newton TF, Cook lA, Holschneider DP, Rosenblatt MR, Lindholm JE, Jarvik MM. (1983). Quantitative EEC effects of nicotine replacement by cigarette smoking. Neuropsychobiology. 37(2) 112-16. 

An understanding of the pharmacology of nicotine and how nicotine produces addiction and influences smoking behavior provides a necessary basis for therapeutic advances in smoking cessation interventions. This chapter provides a review of several aspects of the human pharmacology of nicotine. These include the presence and levels of nicotine and related alkaloids in tobacco products, the absorption of nicotine from tobacco products and nicotine medications, the distribution of nicotine in body tissues, the metabolism and renal excretion of nicotine, nicotine and cotinine blood levels during tobacco use or nicotine replacement therapy, and biomarkers of nicotine exposure. For more details and references on the pharmacokinetics and metabolism of nicotine, the reader is referred to Hukkanen et al. (2005c). 

Nicotine and Cotinine Blood Levels During Tobacco Use and Nicotine Replacement Therapy... 

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