36.92 Handout-NRT & Bupropion combined

Diabetes Planned Visit Notebook

Summa Health System developed this fact sheet for patients who smoke tobacco. Care providers give it to patients during diabetes planned visits, and it is part of the Diabetes Planned Visit Notebook.

Information from Your Family Doctor

Family Medicine Center of Akron Summa Health System

How to Use the Nicotine Patch, Gum, Lozenge, Inhaler, Nasal Spray, and Bupropion

When you are ready to quit smoking, you may want to use nicotine replacement therapy or/and the medication buproprion to help you give up cigarettes. The cost of nicotine replacement therapy is about the same or less than the cost of cigarettes. Some insurance companies may cover the cost of some therapies; ask your doctor or call your insurance carrier to see if yours does.

The nicotine patch, gum, lozenge, nasal spray, and inhaler are all forms of nicotine replacement therapy. All forms of nicotine replacement can help lessen your urge to smoke. This means you have less craving for nicotine when you stop smoking. You may still feel a craving to smoke, but don't smoke while using the patch, gum, nasal spray or inhaler.

For any type of nicotine replacement to be successful, you must stop smoking. If you continue to smoke while using nicotine replacement, you may have symptoms which are pale skin, cold sweats, nausea, vomiting, salivation, abdominal pain, diarrhea, headache, dizziness, confusion, and weakness. A nicotine overdose may cause convulsions and even death. Be sure to read all package instructions for further information before starting the nicotine replacement therapy.

Almost every smoker can benefit from using nicotine replacement therapy

Heart or Blood Vessel Problems: If you have heart or blood vessel problems, your doctor will be careful about giving you the nicotine patch or gum.

Diabetics: This medicine may raise your blood sugar level, talk to your doctor about this.

Females of childbearing age: Tell your doctor if you are pregnant or breast-feeding a baby. Nicotine from any source can harm the baby. Do not become pregnant while using this medicine. If you become pregnant, contact your doctor. Also, using this medicine while breast-feeding an infant is not recommended.

Other possible side effects of nicotine products: Inability to sleep, nervousness.

Community Resources:

Consider taking a free quit smoking class: call 330-861-7179 for list of free local classes or call the Ohio Quit line at 1-800-Quit-Now (1-800-784-8669) for support along with your nicotine replacement or medication. These programs can help you with the habit part of smoking. Quitting may take practice, not everyone can quit the first time.

People who choose to call the Ohio Quit Line or take a quit smoking class are 5 times more likely to succeed than those who try to quit on their own.

Should I use the nicotine patch, gum, lozenge, nasal spray or inhaler?

Any of these treatments can help once you are ready to quit. The choice is up to you. Some people don't like the taste of the gum or don't like chewing in public. They prefer the patch. Other people have been unable to quit on the patch and want to try the gum. Some people prefer to use a nasal spray and some prefer the inhaler. Using nicotine replacement almost doubles your chances of quitting. Here is some information to help you decide which one is right for you.

Nicotine Patch

Directions for use: At the start of each day, place a new patch on a part of your body between the neck and the waist. Choose a non-hairy, clean and dry area of skin. Be sure there are no cuts or irritations. Put the patch on a new spot each day to lessen skin irritation. Do not use the same spot for 1 week.

Dosage: Taken from the Nicoderm CQ® internet site– Dosage may vary by brand. Please check your package instructions.

  • If you smoke more than 10 cigarettes a day, follow the 10-week plan. Use Step 1 (21 mg) for 6 weeks, Step 2 (14 mg) for 2 weeks, and Step 3 (7 mg) for 2 weeks.
  • If you smoke 10 or less cigarettes a day, follow the 8-week plan. Use Step 2 (14mg) for 6 weeks and Step 3 (7mg) for 2 weeks.

Side effects: Some people who use the patch get a rash on their body where the patch is placed. Skin rashes are usually mild and easily treated. Moving the patch to another area of the body helps. If you have any side effects from the patch, be sure to tell your doctor right away.

How to get the patch: You can buy the patch with or without a doctor's prescription. Ask your doctor if your insurance company requires a prescription. To be safe, carefully read and follow the directions inside the package.

Nicotine Gum

Directions for use: The gum must be chewed in a special way to make it work. Chew it slowly until you notice a "peppery" taste or "tingling sensation" Then stop chewing and move the nicotine gum between your cheek and your gum ("parking"). Once the tingling is gone chew again until the sensation comes back. Start and stop for about 30 minutes. You must chew slowly to get full benefit. Avoid eating or drinking for 15 minutes before and during chewing to prevent reduced nicotine absorption.

Dosage: Many smokers should start using the 2-mg dose. However, you may want to start with the 4-mg gum if you:

  • Smoke more than 20 cigarettes a day.
  • Smoke as soon as you wake up in the morning.
  • Have severe withdrawal symptoms when you don't smoke.

If you are a very light smoker (less than 10 to 15 cigarettes a day) or have health problems, your doctor can help you select the right dose.

Treatment period: A regular schedule (at least one piece of nicotine gum every 1 to 2 hours for 1 to 3 months) may give the best results. Or it may be used by chewing one piece of gum whenever you have the urge to smoke. Some people don't chew/park enough pieces of gum a day and or they don't chew the gum for at least 8 weeks. They might not get the most benefit from nicotine gum. Do not use more than 30 pieces in one day. As your urge lessens, usually after about 8 weeks, gradually decrease the amount of gum, until you don't need it anymore.

Side effects: Some people have mild side effects such as hiccups, upset stomach or sore jaws. Most of these side effects go away if the gum is used correctly. If you have any side effects from the gum, be sure to tell your doctor right away.

How to get nicotine gum: You can buy the gum without a doctor's prescription. To be safe, carefully read and follow the directions inside the package. Also, you can talk to your doctor about how to use it and how long to use it.

Nicotine Nasal (nose) Spray

Directions for use: Apply one spray in each nostril. Use the spray one to two times each hour while you are awake. Use the spray at least 8 times a day. Do not use it more than 40 times a day.

Side Effects: The nasal spray may cause nasal irritation, diarrhea and a fast heart rate. If you have hay fever or sinus infection, ask your doctor about using one of the other forms of nicotine replacement therapy.

If you have any side effects from the nasal spray, be sure to tell your doctor right away.

How to get the nasal spray: You can only get the nasal spray with a doctor's prescription. To be safe, carefully read and follow the directions inside the package.

Nicotine Inhaler

Directions for use: Inhale from a cartridge when you have a desire for a cigarette. Usually you will need at least 6 cartridges a day for the first 3-6 weeks. For best results, puff on each cartridge for at least 20 minutes. Puff like a cigar or inhale into cheeks not into lungs. Use no more than 16 cartridges a day for up to 12 weeks.

Side Effects: You might have irritation of throat and mouth when you first start to use the inhaler. It might make you cough. You should get over this after a while.

If you have any side effects from the inhaler, be sure to tell your doctor right away.

How to get the inhaler: You can only get the inhaler with a doctor's prescription. To be safe, carefully read and follow directions inside the package.

Nicotine Lozenge (Commit®)

The nicotine lozenge acts as a substitute oral activity and provides a source of nicotine that reduces the withdrawal symptoms experienced when smoking is stopped. It is recommended for smokers who have tried to quit previously. Be sure to stop smoking on the day you start the lozenge.

Which strength is right for you?

Use 2 mg: If you smoke your first cigarette more than 30 minutes after waking up. Use 4 mg: If you smoke your first cigarette within 30 minutes of waking up.

How to use the Commit® Lozenge properly:

  • Avoid food and beverages 15 minutes before and during use of the Commit® Lozenge.
  • Place the Commit in your mouth and allow the lozenge to dissolve slowly (from about 20-30 minutes). Move the lozenge from one side of the mouth to the other until dissolved.
  • Use no more than 20 lozenges per day.

Nicotine Replacement Therapy handout adapted from the Centers for Disease Control and Prevention handout, "You Can Quit Smoking," retrieved May 2001, from: http://www.cdc.gov/tobacco/quit/canquit.htm. The information in this handout was taken from "Treating Tobacco Use and Dependence," a Public Health Service-sponsored Clinical Practice Guideline. Copyright © 2001 by the American Academy of Family Physicians.

Bupropion Hydrochloride SR (Zyban®, Wellbutrin®)

Congratulations on your decision to quit smoking. Bupropion SR is taken by mouth to help people stop smoking.

How to Use Bupropion SR:

You should start the medicine while you are still smoking because about 1-2 weeks of treatment is necessary to build an effective level of medicine in your blood.

  • Set a target date to stop smoking (usually within the second week of taking this medicine).
  • Take one pill (150mg) every morning for 3 days; then one pill (150mg) twice daily-with 8 hours between each dose. This treatment is continued for 7-12 weeks, depending on your response.
  • Read the information sheet that comes with the medicine.
  • You may use nicotine trans-dermal products (patches) or nicotine gum while taking this medicine. Ask your doctor which is right for you.

Precautions: The active ingredient in Bupropion SR/Zyban is also used for the treatment of depression. Do not take this medicine if you are also taking Wellbutrin or Wellbutrin SR, which contain the same active ingredient, because of the risk of an overdose.

Females of childbearing age: Tell your doctor if you are pregnant or breastfeeding an infant. Do not breastfeed an infant while you are taking this medicine. Insomnia (trouble sleeping) and dry mouth are two of the most common side effects. If these side effects become severe, contact your doctor.

Possible Serious Side Effects: (report these to your doctor right away)
Hives, itching, trouble breathing, severe insomnia, severe dry mouth.

Other possible side effects: anxiety, dizziness, constipation, diarrhea, loss of appetite, runny/stuffy nose, abdominal pain. Tell your doctor if you have any side effects that continue or get worse.

Possible Drug Interactions: When you take this medicine with other medicines, it may increase or decrease the effects of the medicines. Or the combination may cause harmful side effects. Some medicines that may interact with this medicine are: carbamazepine (Tegretol), ritonavir (Norvir), phenytoin (Dilantin), cimetidine (Tagamet), phenobarbital, levodopa (Larodopa, Dopar) and levodopa plus carbidopa (Sinemet), MAO inhibitor antidepressants such as phenelzine (Nardil). Be sure that you tell all doctors who treat you about all medicines you are taking, including non-prescription products.

Current as of January 2008
Internet Citation: 36.92 Handout-NRT & Bupropion combined: Diabetes Planned Visit Notebook. January 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/diabnotebk/diabnotebk3692.html