Nicotine sublingual tablets/lozenges

The odds ratio (OR) for abstinence with NRT compared to control was 1.74 (95% confidence interval [Cl] 1.64 to 1.86). The ORs for the different forms of NRT were 1.66 for gum, 1.74 for patches, 2.27 for nasal spray, 2.08 for inhaled nicotine, and 2.08 for nicotine sublingual tablet/lozenge. These odds were not a function of the duration of therapy, the intensity of additional support provided, or the setting in which the NRT was provided. The 4-mg gum provided a significant benefit over 2-mg gum (OR 2.67 95% Cl 1.69 to 4.22) in highly dependent smokers. Higher doses of nicotine patch may produce additional small increases in quit rates compared to lower doses. Only one study directly compared NRT to another pharmacotherapy, in which bupropion was significantly more effective than nicotine patch or placebo. ... 

The authors of this review concluded that all of the commercially available forms of NRT (nicotine gum, transdermal patch, the nicotine nasal spray, nicotine inhaler, and nicotine sublingual tablets/lozenges) are effective as part of a strategy to promote smoking cessation. They increase quit rates approximately 1.5- to twofold regardless of setting. ... 

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). 

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