Home' Australian Journal of Pharmacy : Jan Feb 2015 Contents WITH DR COLIN MENDELSOHN
Combination NRT (nicotine patch plus an oral form, such as
lozenge or gum) has been shown to be more ef fective than
using a single product alone.
Combination NRT is well tolerated and should be encouraged
in smokers who tried and failed to quit with one form of NRT
before or who experience cravings with monotherapy.
WHAT IS THE RATIONALE?
The nicotine patch provides a steady dose
of nicotine throughout the day to relieve
background cravings caused by low nicotine
levels. However, smokers still experience
breakthrough cravings in response to smoking
triggers, such as coffee, alcohol or stress.
HOW EFFECTIVE IS COMBINATION NRT?
WHO SHOULD RECEIVE COMBINATION NRT?
A Cochrane meta-analysis found that
combination NRT increased quit rates by 34%
compared to using a single nicotine product.1
A further evaluation found that combination NRT
was just as effective as Champix (varenicline)
in helping smokers to quit.4
The Australian smoking cessation guidelines
encourage the use of combination NRT if a
smoker is unable to quit with one NRT product
alone or continues to experience cravings.2
The guidelines also advise that combination NRT
can be recommended as first line treatment.
In fact, some experts now recommend
combination therapy for all dependent smokers
If the patient is experiencing continuing
cravings or withdrawal symptoms it would be
appropriate to add, say, nicotine gum, lozenges
or oral strips to improve control using the lowest
dose strength available equivalent to 2 mg gum,
lozenge or 2.5 mg oral strips.
These quicker-acting products can be used
with the nicotine patch on a regular basis or
as required when cravings occur, up to 12 doses
per day. A full course of 12 weeks of combination
treatment is recommended for best results.
WHAT ARE THE DOSAGE GUIDELINES?
Patients smoking >10 cigarettes per day are
generally started on the full-strength nicotine patch.2
HOW WELL TOLERATED IS NRT?
A review of five randomised controlled trials
of combination NRT found that adverse
effects were minimal and similar to placebo or
monotherapy.5 Combination NRT is generally
well tolerated.2 A full strength nicotine patch
delivers only about half the blood levels of
nicotine compared to smoking, allowing a wide
safety margin for additional nicotine delivery.6
Furthermore, smokers have a tolerance to
nicotine from regular use.
Stop smoking aid. Contains nicotine.
Review the Product Information for nicotine replacement therapy before recommending.
References: 1. Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews (Online).
2012;11:CD000146. PubMed PMID: 23152200. Epub 2012/11/16. eng. 2. Zwar N, Richmond R, Borland R, Peters M, Litt J, Bell J, et al. Supporting smoking cessation: a guide for health professionals.
Melbourne: The Royal Australian College of General Practitioners. 2014. 3. Ferguson SG, Shiffman S. The relevance and treatment of cue-induced cravings in tobacco dependence. Journal of Substance
Abuse Treatment. 2009 Apr;36(3):235–43. PubMed PMID: 18715743. Epub 2008/08/22. eng. 4. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation:
an overview and network meta-analysis. Cochrane Database of Systematic Reviews (Online). 2013;5:CD009329. PubMed PMID: 23728690. Epub 2013/06/04. eng. 5. Shah SD, Wilken LA, Winkler SR,
Lin SJ. Systematic review and meta-analysis of combination therapy for smoking cessation. Journal of the American Pharmacists Association: JAPhA. 2008 Sep-Oct;48(5):659–65. PubMed PMID:
18826906. Epub 2008/10/02. eng. 6. Hukkanen J, Jacob P, 3rd, Benowitz NL. Metabolism and disposition kinetics of nicotine. Pharmacological Reviews. 2005 Mar;57(1):79–115. PubMed PMID:
15734728. Epub 2005/03/01.eng.
GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington, NSW 2115. CHANZ/CHNIC/0814/14d. GSK1427/UC. January 2015.
Acute nicotine delivery from oral NRT products
such as nicotine gum, lozenge and oral strips
allows the smoker increased control over these
Combination NRT is
therefore effective against both types of cravings
(background and cue-induced) and also delivers
higher doses of nicotine.
What’s the take-home message for pharmacists?
When you recommend combination NRT, you’re offering customers
a greater chance of quitting success compared to a single product alone,
and a therapy that’s as effective as prescription-only Champix.1,4
NICOTINE REPLACEMENT THERAPY (NRT)
GSK1427 - 1 2015-01-08T12:41:15+11:00
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