January - Quit Smoking

Quit smoking

If patients want to stop smoking, several different treatments are available to help them beat their addiction and reduce withdrawal symptoms. The best treatment for us to recommend is depending on patients’ personal preference, age, whether they're pregnant or breastfeeding and any medical conditions they have.

Here are some treatments which are available in our pharmacy and describing below.

 

Ø  Nicotine replacement therapy

First optional treatment is Nicotine replacement therapy (NRT). The main reason that people smoke is because they are addicted to nicotine, NRT is a medication that provides a low level of nicotine, without the tar, carbon monoxide and other poisonous chemicals present in tobacco smoke. It can help reduce unpleasant withdrawal effects, such as bad moods and cravings, which may occur when people stop smoking. Usually, NRT is available as skin patches, chewing gum, inhalators (which look like plastic cigarettes), tablets, oral strips and lozenges, nasal and mouth spray. [1]

In Lotus Pharmacy, Nicotinell Mint 2mg medicated chewing gum, Nicotinell Fruit 2mg  medicated chewing gum (nicotine polacrilin) and Nicotinell TTS Patch 10 (nicotine) are available for NRT therapy.

 

Dosage and method of use Gum: [2]

1. If patient is and adult or elderly, we should recommend they to chew one piece of gum when urge to smoke is felt. Normally 8 to12 pieces per day, up to a maximum of 25 pieces of 2mg gum per day or 15 pieces of 4mg gum per day. After 3 months, gradually cut down the gum usage. If patient have a strong nicotine dependency, we may need to order the 4mg gum for them because 2 mg is not effective enough.

2. If patient is an adolescent (12 to 18 years), the dosage and method are as for adults but seek medical advice if more than 12 weeks treatment required.

*Keep out of the reach and sight of children at all times due to potential poisoning risk.

 

 

Method of use Patches: [2]

1. For adults those smoking ≥20 cigarettes a day: we should order Nicotinell TTS30 (Step 1) once daily.

2. For adults those smoking <20 start with Nicotinell TTS20 (This would be Step 2, if patient passed the Step 1) once daily. Reduce nicotine dose over treatment periods of 3 to 4 weeks by reducing patch strength in stepwise fashion. Use continuously for three months, if abstinence not achieved after 3 months further treatments may be recommended.

3. For adolescents (12 to 18 years), recommendations were followed above. Seek medical advice if treatment is required for longer than 12 weeks.

*Discontinue use if a severe or persistent skin reaction occurs. Nicotinell TTS contains aluminum and should be removed prior to undergoing defibrillation, MRI or cardio version procedures.

*Keep out of the reach and sight of children at all times due to potential poisoning risk.

 

**Before we recommend NRT to patients, we need to check if they have related conditions (Contraindications and Precautions) show below:

1. NRT should not be advised to person who have known hypersensitivity to nicotine or any of the excipients and non-smokers. [2]

2.NRT need to use with caution in patients with cardiovascular disease, history of seizure or those taking anti-convulsant therapy, diabetes mellitus, hyperthyroidism, pheochromocytoma, moderate to severe renal and/or hepatic impairment, active oesophagitis, oral and pharyngeal inflammation, gastritis, gastric/peptic ulcer. [2]

** After we give patients NRT, it’s necessary for us to tell them the possible side effects for NRT: skin irritation when using patches, difficulty sleeping (insomnia), sometimes with vivid dreams, upset stomach, dizziness and headaches.[1]

 

**If patient is a pregnant woman:

NRT is acceptable for pregnancy if her doctor think it is helpful. [1]If she has pregnancy-related nausea and vomiting, patches may be a better solution. NRT patches should be used for no more than 16 hours in any 24-hour period. The best way to remember this is to remove the patch at bedtime. [3]

However, before using any of these products, we still need to advise and confirm that pregnant have spoken to a midwife, GP, a pharmacist or a specialist stop smoking adviser.

 

**If patient is a breastfeeding woman:

NRT is usable but they should ask doctor to advise how to do this safely. [1]

 

Ø  Varenicline (Champix)

The second treatment to quit smoking is Varenicline (brand name Champix ® /戒必適®), which is also available is Lotus Pharmacy as Champix Tab 0.5mg&1mg and Champix Tab 1mg. This is a medicine that works in 2 ways. It reduces cravings for nicotine like NRT, but it also blocks the rewarding and reinforcing effects of smoking. Evidence suggests it's the most effective medicine for helping people stop smoking. [1][4]

Dosage and method of use Champix [5]:

Days 1~3

Take Champix Tab 0.5mg once daily.

Days 4~7

Take Champix Tab 0.5mg twice daily.

Days 8~ end of treatment

Take Champix Tab 1mg once daily.

Champix dosing should usually start at 1-2 weeks before this date. Patients should be treated with Champix for 12 weeks.For patients who have successfully stopped smoking at the end of 12 weeks, an additional course of 12 weeks treatment with CHAMPIX at 1 mg twice daily may be considered for the maintenance of abstinence. [5]

*Champix is not suitable for: children under 18 years of age, women who are pregnant or breastfeeding, people with severe kidney problems. [1]

Also, we need to remain patient that there are some Possible Side effects of CHAMPIX may occur including insomnia, sometimes with vivid dreams, dry mouth, constipation or diarrhea, headaches and drowsiness.[1]

 

 

 

 

References:

1.https://www.nhs.uk/conditions/stop-smoking-treatments/

2.https://www.gskhealthpartner.com/en-gb/respiratory-health/brands/nicotinell/products/

3.https://www.nhs.uk/conditions/pregnancy-and-baby/smoking-pregnant/

4.https://www.pfizer.com.hk/zh-hant/champix%C2%AE-%E6%88%92%E5%BF%85%E9%81%A9%C2%AE

5.https://www.medicines.org.uk/emc/product/266/smpc#gref