Recommended ST Treatment Approach 1) Behavioral treatment –Oral examination –+/- oral replacement products 2) Bupropion –150 mg po qd x 3 days then bid –Quit 1 week later –Continue for 3-6 months 3) Tailored nicotine patch therapy –+/- gum/lozenge for self-titration
Smokeless Tobacco Pharmacology Potential available nicotine is twice that obtained from smoking a cigarette (per unit dose): Potential available nicotine is twice that obtained from smoking a cigarette (per unit dose): chewing tobacco4.5 mg moist snuff3.6 mg 4 mg nicotine gum1.9 mg cigarette 1.8 mg
Nicotine Gum for ST Use Should not be used as monotherapy Should not be used as monotherapy 4 mg 4 mg Frequent use initially (10-15/day) Frequent use initially (10-15/day)
Nicotine Lozenge for ST Use Nicotine Polacrilex Nicotine Polacrilex –2 mg –4 mg 1-2 lozenges every 1- 2 hours 1-2 lozenges every 1- 2 hours Minimum of 9/day Minimum of 9/day Taper over 12 weeks Taper over 12 weeks
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