NC STEP/Mission Hospitals’ NC STEP/Mission Hospitals’ School Cessation and School Cessation and

Treatment GuideTreatment Guide

Cessation GuideCessation Guide

Treatment GuideTreatment Guide

Recommended ST Treatment Recommended ST Treatment ApproachApproach1) Behavioral treatment1) Behavioral treatment

– Oral examinationOral examination– +/- oral replacement products+/- oral replacement products

2) Bupropion2) Bupropion– 150 mg po qd x 3 days then bid150 mg po qd x 3 days then bid– Quit 1 week laterQuit 1 week later– Continue for 3-6 monthsContinue for 3-6 months

3) Tailored nicotine patch therapy3) Tailored nicotine patch therapy– +/- gum/lozenge for self-titration+/- gum/lozenge for self-titration

Smokeless Tobacco Smokeless Tobacco PharmacologyPharmacology

• Potential available nicotine is twice that obtained Potential available nicotine is twice that obtained from smoking a cigarette (per unit dose):from smoking a cigarette (per unit dose):

chewing tobaccochewing tobacco 4.5 mg4.5 mg

moist snuffmoist snuff 3.6 mg3.6 mg

4 mg nicotine gum4 mg nicotine gum 1.9 mg1.9 mg

cigarettecigarette 1.8 mg1.8 mg

Nicotine Gum for ST UseNicotine Gum for ST Use

• Should not be used as Should not be used as monotherapymonotherapy

• 4 mg4 mg

• Frequent use initially (10-15/day)Frequent use initially (10-15/day)

Nicotine Lozenge for ST UseNicotine Lozenge for ST Use

• Nicotine PolacrilexNicotine Polacrilex– 2 mg2 mg– 4 mg4 mg

• 1-2 lozenges every 1-2 lozenges every 1-2 hours 1-2 hours

• Minimum of 9/dayMinimum of 9/day

• Taper over 12 Taper over 12 weeksweeks

Pharmacologic Treatment:Pharmacologic Treatment:

Nicotine Patch Percentage Nicotine Patch Percentage ReplacementReplacement

Peak serumPeak serumnicotinenicotine

concentrationsconcentrations(ng/mL)(ng/mL)

Cans or pouchesCans or pouchesper weekper week Patch dosePatch dose

LowLow 0-100-10 = 1= 1 14 mg/d14 mg/d

IntermediateIntermediate 11-2011-20 2-32-3 21or 22 mg/d21or 22 mg/d

HighHigh > 20> 20 > 3> 3 42 or 44 mg/d42 or 44 mg/d

NRT for ST Users

Bupropion SR for ST UseBupropion SR for ST Use

DosingDosing

150 mg daily for 3-4 days150 mg daily for 3-4 days

thenthen

150 mg twice a day for 3-4 days150 mg twice a day for 3-4 days

THENTHEN

STOP TobaccoSTOP Tobacco