VOL: 101, ISSUE: 09, PAGE NO: 32Generic/proprietary names
- Nicotine replacement therapy (NRT), nicotine, Nicorette, Nicotinell, NiQuitin.
- NRT acts as an agonist at nicotine receptors.
- Drugs used in substance dependence.
- Ganglionic cholinergic agonist.
- Smoking cessation.
- NICE recommends that NRT should only be prescribed for a smoker who has committed to a target quit date.
- Severe cardiovascular disease.
- Recent cerebrovascular accident.
- Cardiovascular disease.
- Peripheral vascular disease.
- Renal or hepatic impairment.
- Headache and cold-like symptoms.
- Vivid dreams.
- Local reaction depends on product.
- Impaired concentration.
- Abnormal hunger.
- Increases insulin absorption.
- Raises blood levels of some drugs including caffeine, theophylline, imipramine and propranolol.
- 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.
- 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.
- 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.