Table 3.

First-line Tobacco Dependence Treatment (Information from Treating Tobacco Use and Dependence Guideline. ⁸ and Ebbert et al)

Drug	Dosing & Prescribing Instructions	Precautions	Availability
NRT—Nicotine Patch	Treatment for 8 weeks based on cigarettes per day (cpd). ≥10cpd 21 mg patch/24 hours for 4 weeks, then 14 mg patch/24 hours for 2 weeks, then 7 mg patch/24 hours for 2 weeks. 16-and 24- hour patches are of comparable efficacy If patients experience sleep disruption, they should remove the 24-hour patch at bedtime or use the 16-hour patch.	Skin reactions: Skin reactions are usually mild and self-limiting, but may worsen over the course of therapy. Skin reactions can be treated by rotating patch sites or applying hydrocortisone cream (1%) or triamcinolone cream (0.5%). Other side effects-Insomnia	Nicoderm®CQ®, Nicotrol®, generic-OTC
NRT-Nicotine Nasal Spray	One spray to each nostril 1–2 times/hour. Recommended treatment is between 8 and 40 doses/day. Recommended duration of treatment is 3–6 months. Fastest delivery of nicotine	Nasal Irritation: Nasal congestion and transient changes in sense of smell and taste were reported. The majority of users reported moderate to severe nasal irritation within the first two days	Nicotrol® NS- Prescription only
NRT-Inhaler	One dose from the inhaler consists of a puff or inhalation. Recommended dosage is 6–16 cartridges/day (each cartridge deliver 4mg of nicotine over 80 inhalations). Recommended duration of therapy is up to 6 months Acidic beverages (coffee, juices, soft drinks) interfere with the buccal absorption of nicotine, so these should be avoided 15 minutes before and during inhalation.	Local irritation reactions: Local irritation in the mouth and throat was observed in 40% of the patients. Coughing and rhinitis were also reported, but the frequency of symptoms declined with continued use.	Nicotrol® Inhaler-Prescription only
NRT-Nicotine gum	The 2mg gum is recommended for patients smoking < 25 cpd, while the 4mg gum is recommended for the patients smoking ≥ 25 cpd. No more than 24 pieces/day should be consumed. Can be used up to 12 weeks. Gum should be chewed slowly until a “minty” taste emerges, then “parked” between check and gum to facilitate nicotine absorption. Eating and drinking anything except water should be avoided for 15 minutes before and during chewing	Side Effects: Mouth soreness, hiccups, dyspepsia, jaw ache	Nicorette® (Original, Mint, FreshMint™, FruitChill™) -OTC
NRT- Commit Lozenge	Dosing is based on time to first cigarette; < 30 minutes of waking up, 4mg lozenge; > 30 minutes, 2mg. Recommended dose: Weeks 1–6: 1 lozenge every 1–2 hours. Weeks 7–9: take 1 lozenge every 2–4 hours. And weeks 9–12: 1 lozenge every 4–8 hours. Do not consume more than 1 lozenge at a time, with a maximum of 5 lozenges in 6 hours. Allow the lozenge to slowly dissolve in their mouth. Avoid chewing or swallowing lozenge. A tingling sensation may be experienced during consumption, which indicates that it is working. Occasionally shift the lozenge from either side of the mouth during the 20–30 minute time period in which it takes to fully dissolve. Do not eat or drink 15 minutes before using, or while using the lozenge.	Side Effects: may include heart palpitations, nausea, vomiting and weakness.	Commit® Lozenge (mint or cherry)--OTC
Bupropion SR	Begin 1–2 weeks before target quit date (TQD). Start with a dose of 150mg q AM for 3 days, then increase to 150mg b.i.d for 4 days. On TQD, continue dosing at 150mg b.i.d. for 7–12 weeks. Maintenance therapy may last up to 6 months. Some patients will lose their desire to smoke prior to their quite date, or will spontaneously reduce the amount they smoke. If insomnia is marked, take the PM dose earlier in the afternoon. Use alcohol in moderation.	Cardiovascular disease: generally well tolerated, infrequent reports of hypertension Side Effects: most commonly reported are insomnia and dry mouth Contraindications: Seizure disorder, eating disorder, using another form of bupropion or used an MAOI in the past 14 days	Zyban®—Prescription only
Vareceline	Start taking 1 week before TQD. Days 1–3, 0.5 mg q.d., then take 0.5 b.i.d for 4 days; On TQD 1.0 mg b.i.d. daily for 11 weeks. Take with food.	Side effects: mild to moderate nausea, vomiting, sleep disturbances, constipation and gas. Risks of toxicity may be increased in patients with impaired renal function.	Chantix®-Prescription only, no generics available at this time