132. Treatment Recommendations: Medications-Nicotine Gum
|Patient selection||Appropriate as a first-line medication for treating tobacco use|
|Precautions, warnings, contraindications and side effects (see FDA package insert for complete list)||Pregnancy-Pregnant smokers should be encouraged to quit without medication. Nicotine gum has not been shown to be effective for treating tobacco dependence in pregnant smokers. (Nicotine gum is an FDA pregnancy Class D agent.) Nicotine gum has not been evaluated in breast-feeding patients.
Cardiovascular diseases-NRT is not an independent risk factor for acute myocardial events. NRT should be used with caution among particular cardiovascular patient groups: those in the immediate (within 2 weeks) post myocardial infarction period, those with serious arrhythmias, and those with unstable angina pectoris.
Side effects-Common side effects of nicotine gum include mouth soreness, hiccups, dyspepsia, and jaw ache. These effects are generally mild and transient, and often can be alleviated by correcting the patient's chewing technique.
|Dosage||Nicotine gum (both regular and flavored) is available in 2 mg and 4 mg (per piece) doses. The 2 mg gum is recommended for patients smoking less than 25 cigarettes per day, while the 4 mg gum is recommended for patients smoking 25 or more cigarettes per day. Smokers should use at least 1 piece every 1 to 2 hours for the first six weeks and the gum should be used for up to 12 weeks with no more than 24 pieces/day.|