smoking therapeutics

first line

• Bupropion SR

• Nicotine RT likes gums, lozenges

• Varenicline

2nd line

• Clonidine

• Nortriptylline

2 mg should be taken if

You smoke your first cigar more than 30 minutes after waking

4mg should be taken if

cigar smoke within 30 mins after waking

Gum

No more than 24 a day

• Weeks 1-6

  • 1 q 1-2 hours

• Weeks 7-9

  • 1 q 2-4 hours

• Weeks 10-12

  • 1 q 4-8 hours

Lozenge

No more than 20 a day

• Weeks 1-6

  • 1 q 1-2 hours

• Weeks 7-9

  • 1 q 2-4 hours

• Weeks 10-12

  • 1 q 4-8 hours

What is the minimum lozenge that needs to be used per day for first 6 weeks?

9 lozenges

Nicotine patches dosing

• If you smoke more than 10 cigs a day:

  • Weeks 1-6: 21 mg

  • Weeks 7-8: 14 mg

  • Weeks 9-10: 7mg

• If you smoke less than 10 cigs a day:

  • Weeks 1-6: 14 mg

  • Weeks 7-8: 7mg

Nicotine spray

• 0.5 mg nicotine/nostril

• Dose is 1mg

• Start off 1-2 doses/hr

• Then increase to max of 5 doses/hr or 40mg daily

• Atleast 8 doses a day for 6-8 weeks and then taper off for 4-6 weeks

Bupropion SR

• Start 1-2 weeks before quit date

• First 3 days 150 mg/day

• Then bid for 7-12 wks

• Post quitting up to 6 months 150mg/day

• No tapering necessary

Varenicline

• Start 1 wk before quitting

• Days 1-3: 0.5mg

• Days 4-7: 0.5 mg bid

• Days 8-35: 1mg bid and quit smoking