E-Cigarettes and Nicotine Replacement Therapy

Smoking Cessation Aids

• Electronic cigarettes work by delivering nicotine vapor into the lungs as a person inhales, providing a hand-to-mouth ritual similar to smoking.
• Each cartridge is inserted into the inhalator and air is drawn into the mouth through the mouthpiece.
• Recommended usage is 6-12 cartridges per day.

Side Effects

• Sore throat, nausea, hiccups, cough, headache, and runny nose.

Nicotinic Receptor Antagonists

• Examples include Bupropion and Varenicline, which are the only two nicotine-free pharmaceuticals approved for smoking cessation.
• They act as competitive antagonists of nicotine for its receptors.
• Generally well tolerated by smokers, except for pregnant or breastfeeding women.
• Help with the craving for nicotine and withdrawal symptoms by working in the brain to reduce physical effects of nicotine.

Antidepressants

• Examples include benzodiazepines, which are not commonly used in smoking cessation.

Concomitant Smoking

• Concomitant use of NRT, Bupropion, or Varenicline and smoking is well tolerated.
• Number of cigarettes smoked is likely to be less than at baseline, resulting in reduced health hazards.

Counseling Patients in Smoking Cessation

• Pharmacists play a proactive role in promoting health and encouraging positive behavioral changes.
• Provide patients with information on the risks associated with smoking.
• Encourage abstinence by directly advising the patient on how to quit and highlighting benefits of stopping smoking.

Health Benefits of Smoking Cessation

• Decreased carbon monoxide levels
• Restoration of olfactory and gustatory senses
• Increased self-respect, sense of accomplishment
• Improved lung function (up to 30%) within 2-3 months
• Reduction in the risk of coronary heart disease (50%) after 1 year
• Progressive decline in the risk of lung cancer as the number of years of abstinence increases

The Five As Approach

• Ask patients if they smoke
• Advise patients who smoke to quit
• Assess the patient's willingness to quit
• Assist the patient in efforts to quit through counseling and/or pharmacologic therapy
• Arrange follow-up within a short time frame

Pharmacotherapy for Smoking Cessation

• Nicotine replacement therapy (NRT)
• Nicotinic receptor antagonists
• Antidepressants

Nicotine Replacement Therapy (NRT)

• Overview: NRT is a smoking-cessation aid used to ameliorate nicotine withdrawal symptoms by providing a non-tobacco, controlled-release amount of nicotine.
• Increases the chance of quitting smoking by about 50-70%.
• Nicotine dose from NRT is lower and administered more gradually than with smoking, reducing addictive potential.

Dosage Forms of NRT

• Nicotine Gum
  • Available in 2mg or 4mg pieces
  • Heavy smokers use the 4mg pieces
  • Daily dose should not exceed 15 pieces
  • Side-effects: Mouth ulcer, nausea, hiccups, insomnia, jaw pain, and dental problems
• Nicotine Lozenges
  • Available in 2mg or 4mg strengths
  • Daily dose should not exceed 20 lozenges
  • Side-effects: Sore throat, insomnia, nausea, and hiccups
• Transdermal Nicotine Patches
  • Available in different strengths per patch
  • Attach to a cleaned part of the body such as arm, wrist, or chest
  • May be worn for 16-24 hours/day
  • Side-effects: Insomnia, vivid dreams, and skin irritation
• Nicotine Inhaler
  • Side-effects: Not specified