Nicotine Replacement Therapies have been a historically popular choice for decreasing dependence on nicotine. One of the most popular (nicotine replacement therapies) available on the market today is the nicotine patch, approved by the FDA in 1991 as a prescription drug. First introduced in the U.S. By prescription only in 1992, the patch could be bought over-the-counter beginning in 1996. Other forms of medicinal nicotine products include, inhalers, and a spray. In recent years, the use of NRTs has gone down, in favor of other methods such as tapering with electronic nicotine delivery systems (ENDS), however, the patch is still available as an option and there are some things about it you should know if considering it for smoking cessation. The nicotine patch provides a steady, controlled dose of nicotine throughout the day, thereby reducing the effects of nicotine withdrawal.
Patch strength is reduced over time, allowing the user to wean themselves off of nicotine gradually. According to Clinical Practice Guidelines put out by the U.S. Department of Health and Human Services in 2008, of the seven first-line medications that consistently have been found to increase long-term abstinence rates: Bupropion SR, Varenicline, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, and the nicotine patch, all five of NRTs have about the same level of efficacy. One major benefit, according to a study published in the Archives of Internal Medicine, is that more people correctly use the patch than they do any other NRT. Doing this increases the potential however for overdose so be careful. The combination of counseling and medication is more effective than either alone. The HHS Clinical Practice Guidelines do not mention electronic cigarettes, which have risen in popularity in recent years, possibly because they have not been through the same FDA approval process as NRTs.
According to a 2019 study in the New England Journal of Medicine, of 886 participants randomized to either nicotine-replacement products or an e-cigarette starter pack, the 1-year abstinence rate was 18.0% in the e-cigarette group, compared with 9.9% in the nicotine-replacement group. It was found that those in the nicotine replacement group were less likely than those in the e-cigarette group to use their assigned product, which speaks to a role for pleasure in successful harm reduction strategies, though more research is needed.
According to the CDC, tobacco use is the single largest preventable cause of death and disease in the United States. Despite continuing declines in cigarette smoking, it kills an estimated 480,000 Americans every year. Additionally, smoking-related illness in the United States costs in excess of $300 billion a year, including nearly $170 billion in direct medical care and $156 billion in lost productivity.Over the years, a number of landmark clinical studies on smoking cessation pharmacotherapy have been published, shaping how we treat people today. Here are 5 of those that every pharmacist should know:1. Effectiveness of Nicotine Replacement Therapy (2012) 1Nicotine replacement therapy (NRT) is used to reduce an individual’s motivation to smoke and manage cravings to ultimately help quit.
NRT has been used for more than 30 years and is currently available in 5 different formations including a patch, gum, lozenge, inhaler, and nasal spray.In a 2012 article published in BMJ, researchers conducted a meta-analysis to further define the effectiveness of NRT. They sought to assess if differences exist in effect among different forms of NRT in achieving abstinence and whether a combination of NRT is more likely to lead to successful quitting than one type alone. In their analysis, researchers identified 117 clinical studies with more than 50,000 combined participants.Study researchers noted that all forms of NRT can help people increase their chances of successfully stopping smoking although there are no clear differences in effectiveness between them. Evidence showed that combining a nicotine patch with a more rapid delivery form of NRT was more effective than a single type of NRT. Additionally, combination of NRT and bupropion was more effective than bupropion alone. There was no evidence from the analysis that NRT increases the risk of heart attacks.ConclusionThere are no differences in effectiveness between different forms of NRT; however, using a combination approach may be beneficial to improve quit rates.2. EAGLES Study (2016) 2Both Chantix (varenicline) and Zyban (bupropion) have been shown in clinical studies to significantly improve long-term smoking abstinence rates; however, safety concerns have been raised regarding their risk of neuropsychiatric events.
Wellbutrin And Nicotine Patch Together
Although studies have not supported any increased risk, the FDA mandated the manufacturers add boxed warnings in the prescribing information of each product. Due to the sensitivity of this adverse effect, and to give clinicians greater clarity regarding any potential risk, researchers conducted the largest study of its kind on this topic.In a 2016 article, researchers described the methodology and results of a randomized, double-blind, placebo and active-controlled trial of varenicline and bupropion. Timothy O'Shea, MS, PharmDTimothy O'Shea, MS, PharmD, is a Clinical Pharmacist working at a regional health insurance plan on the east coast.
Additionally he works per diem at a nationwide retail pharmacy chain. He graduated from MCPHS University - Boston in 2015 and subsequently completed a PGY-1 Managed Care Pharmacy Residency. He completed his M.S.
In Health Services Administration, with a focus on Health Economics and Outcomes, in 2018. His professional interests include pharmacy legislation and managed care pharmacy. He can be followed on Twitter at @toshea125.