Tobacco Treatment Medication Dosing Chart Nicotine Patch Nicotine Gum Nicotine Lozenge Nicotine Nasal Spray Nicotine Inhaler Bupropion SR Varenicline Name/Generic Available Strength Time to peak Plasma level Possible Reactions *Additional *Additional warnings:
warnings: see back Instructions Cost (Average) For Maximum indications Cautions
Pregnancy, unstable coronary syndrome (ischemia, serious arrhythmia, angina) or peptic ulcer (gum and lozenge), under age 18.
Rx Duration Treatment is recommended for at least 3 months but may be up to 6 months or longer, depending on confidence of individual. Consult physician if considering a longer duration. Medication Dosing Guidelines for the Treatment of Smokeless Tobacco and Cigars
Patch: 21 mg QD x 4-6 weeks Gum or Lozenge: 4mg
1 Can/week or more (note: one can is roughly equal to 4
The PHS Clinical Practice Guideline 2008 update does not
recommend use of tobacco treatment medications for
smokeless tobacco use due to lack of sufficient evidence of
Patch: 14 mg x 4-6 weeks Gum or Lozenge: 2mg
If used, suggested dosing is based on rough equivalence of
The PHS Clinical Practice Guideline 2008 update does not
recommend use of tobacco treatment medications for cigar
use due to lack of sufficient evidence of its efficacy.
Patch: 21 mg patch x 4 weeks Gum or Lozenge: 4mg
If used, suggested dosing is based on rough equivalence of
Then 14 mg patch x 2 weeks Inhaler: 6 – 16
Consumers of small and/or little cigars often smoke in
similar pattern to those who smoke cigarettes.
Patch: 21 mg patch x 4 weeks Gum or Lozenge: 4mg
Then 14 mg patch x 2 weeks Inhaler: 6 – 16
The variety of products and patterns of use make it difficult
to suggest dosing guidelines. Suggest assessing number of
cigars smoked and time to first cigar smoked in the a.m. as
possible guidelines. With use of gum, lozenge, inhaler and nasal spray patient can self-titrate based on experience of withdrawal symptoms. Discuss symptoms of possible nicotine overdose. Review risks and benefits.
This chart is strictly for the convenience of consumers and providers. Consumers are advised to consult a physician, nurse or tobacco treatment specialist for more information regarding individual circumstances. Providers are advised to consult the Physician’s Desk Reference or manufacturer for complete product information. Prices are approximations based on those fougust 2009. Prices may change over time and vary according to area. By comparison, the average price of cigarettes in Maine as of 02/09 is $6-$7 per pack.
*Note concerning use of bupropion and varenicline:
• The FDA advises that a person taking varenicline or bupropion who experiences the following should stop taking it and contact a healthcare provider immediately. -Agitation -Hostility -Depressed Mood - Changes in behavior or thinking that are not typical for the person -Suicidal thoughts or behavior See for updates.
• Also note: Serious allergic or inflammatory reaction: Some allergic reactions have been reported that should be referred for immediate medical help. This has been noted in the varenicline post-marketing monitoring, but can occur with any medication: -Swelling - especially of the face, lips, tongue, throat, neck - Hives -Breathing difficulties -Blistering rash in the mouth or on the skin
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