138. Treatment Recommendations: Medications-Nicotine Lozenge

Treating Tobacco Use and Dependence: 2008 Update

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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. The nicotine lozenge has not been shown to be effective for treating tobacco dependence for pregnant smokers. The nicotine lozenge has not been evaluated in breast-feeding patients. Because the lozenge was approved as an over-the-counter agent, it was not evaluated by the FDA for teratogenicity.

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) postmyocardial infarction period, those with serious arrhythmias, and those with unstable angina pectoris.

Side effects-The most common side effects of the nicotine lozenge are nausea, hiccups, and heartburn. Individuals on the 4 mg lozenge also had increased rates of headache and coughing (less than 10% of participants).

Dosage Nicotine lozenges are available in 2 mg and 4 mg (per piece) doses. The 2 mg lozenge is recommended for patients who smoke their first cigarette more than 30 minutes after waking, while the 4 mg lozenge is recommended for patients who smoke their first cigarette within 30 minutes of waking. Generally, smokers should use at least 9 lozenges per day in the first six weeks. The lozenge should be used for up to 12 weeks with no more than 20 lozenges/day.

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Page last reviewed October 2014
Page originally created September 2012
Internet Citation: 138. Treatment Recommendations: Medications-Nicotine Lozenge. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/presentations/2008update-full/slide138.html