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Nicotine replacement therapy

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VOL: 101, ISSUE: 09, PAGE NO: 32

Generic/proprietary names

Generic/proprietary names
- Nicotine replacement therapy (NRT), nicotine, Nicorette, Nicotinell, NiQuitin.

Action
- NRT acts as an agonist at nicotine receptors.

Classification
- Drugs used in substance dependence.

- Ganglionic cholinergic agonist.

Indications
- Smoking cessation.

- NICE recommends that NRT should only be prescribed for a smoker who has committed to a target quit date.

Contraindications
- Severe cardiovascular disease.

- Recent cerebrovascular accident.

Cautions
- Cardiovascular disease.

- Peripheral vascular disease.

- Hyperthyroidism.

- Diabetes.

- Phaeochromocytoma.

- Renal or hepatic impairment.

- Pregnancy.

Common side-effects
- Nausea.

- Dizziness.

- Headache and cold-like symptoms.

- Palpitations.

- Dyspepsia.

- Insomnia.

- Vivid dreams.

- Myalgia.

- Local reaction depends on product.

Rare side-effects
- Impaired concentration.

- Abnormal hunger.

- Dysmenorrhoea.

Interactions
- Increases insulin absorption.

- Raises blood levels of some drugs including caffeine, theophylline, imipramine and propranolol.

Administration
- Patient preference usually dictates the choice of NRT preparation.

- Nicotine patches deliver a steady dose but this cannot be increased quickly to combat strong cravings.

- Nicotine gum, sublingual tablets or lozenges can be used for a craving.

- Nicotine inhalator is a plastic holder with nicotine cartridges.

- Nicotine nasal spray is useful for the most heavily dependent smokers.

Nursing considerations
- NICE guidance recommends that an initial supply of NRT should be two weeks and a second prescription should only be given if a continuing commitment to stopping smoking can be demonstrated.

- Exercise may increase absorption and side-effects from patches.

- NRT patches should only be used on intact skin.

- Inspect site of administration for local reaction, such as rashes from patches and irritation of buccal cavity for gum.

- Evaluate therapeutic response.

- Smoking cessation is more likely to be successful if counselling or support is received while taking NRT.

Patient teaching
- Ensure that patients are aware that NRT does not stop them smoking. The determination to break the smoking habit is essential to success.

- Patients should start NRT straight away on the day they have chosen to stop smoking.

- Patients should use NRT regularly at first.

- For the best chance of successful smoking cessation, patients should use NRT for at least 8-12 weeks.

- Ensure that the patient has information about local support groups and services.

- Patients should not smoke while taking NRT.

Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines.

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