BNF for Children 2011-2012

240 4.10.2 Nicotine dependence BNFC 2011–20124 Central nervous systemAdministration Chew the gum until the taste becomesstrong, then rest it between the cheek and gum; whenthe taste starts to fade, repeat this process. One piece ofgum lasts for approximately 30 minutes.Nicotine inhalation cartridge The cartridges can beused when the urge to smoke occurs or to preventcravings, up to a maximum of 12 cartridges daily.Administration Insert the cartridge into the device anddraw in air through the mouthpiece. The amount ofnicotine from 1 puff of the cartridge is less than thatfrom a cigarette, therefore it is necessary to inhale moreoften than when smoking a cigarette. A single cartridgelasts for approximately 20 minutes of intense use.Nicotine lozenge One lozenge should be used every1–2 hours when the urge to smoke occurs. Individualswho smoke less than 20 cigarettes each day shouldusually use the lower-strength lozenges; individualswho smoke more than 20 cigarettes each day andthose who fail to stop smoking with the low-strengthlozenges should use the higher-strength lozenges. Individualsshould not exceed 15 lozenges daily. If attemptingsmoking cessation, treatment should continue for 6–12 weeks before attempting a reduction in dose.Administration Slowly allow each lozenge to dissolvein the mouth; periodically move the lozenge from oneside of the mouth to the other. Lozenges last for 10–30minutes, depending on their size.Nicotine sublingual tablets Individuals who smokefewer than 20 cigarettes each day should initially use 1tablet each hour, increased to 2 tablets each hour ifnecessary; individuals who smoke more than 20 cigaretteseach day should use 2 tablets each hour. Individualsshould not exceed 40 tablets daily. If attemptingsmoking cessation, treatment should continue for up to3 months before reducing the dose.Administration Each tablet should be placed under thetongue and allowed to dissolve.Nicotine oral spray Individuals can use 1–2 sprays inthe mouth when the urge to smoke occurs. Individualsshould not exceed 2 sprays per episode (up to 4 spraysevery hour), and a maximum of 64 sprays daily.Administration The oral spray should be released intothe mouth, holding the spray as close to the mouth aspossible and avoiding the lips. The individual should notinhale while spraying and avoid swallowing for a fewseconds after use.Note If using the oral spray for the first time, or if unit not usedfor 2 or more days, prime the unit before administrationNicotine nasal spray Individuals can use 1 spray ineach nostril when the urge to smoke occurs, up to twiceevery hour for 16 hours daily (maximum 64 spraysdaily). If attempting smoking cessation, treatmentshould continue for 8 weeks before reducing the dose.Administration Initially 1 spray should be used in bothnostrils but when withdrawing from therapy, the dosecan be gradually reduced to 1 spray in 1 nostril.Nicotine transdermal patches As a general guidefor smoking cessation, individuals who smoke morethan 10 cigarettes daily should apply a high-strengthpatch daily for 6–8 weeks, followed by the mediumstrength patch for 2 weeks, and then the low-strengthpatch for the final 2 weeks; individuals who smoke fewerthan 10 cigarettes daily can usually start with themedium-strength patch for 6–8 weeks, followed by thelow-strength patch for 2–4 weeks. A slower titrationschedule can be used in patients who are not ready toquit but want to reduce cigarette consumption before aquit attempt.If abstinence is not achieved, or if withdrawal symptomsare experienced, the strength of the patch used shouldbe maintained or increased until the patient is stabilised.Individuals using the high-strength patch who experienceexcessive side-effects, that do not resolve within afew days, should change to a medium-strength patch forthe remainder of the initial period and then use the lowstrength patch for 2–4 weeks.Administration Patches should be applied on waking todry, non-hairy skin on the hip, trunk, or upper arm andheld in position for 10–20 seconds to ensure adhesion;place next patch on a different area and avoid using thesame site for several days.NICOTINECautions see notes aboveHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes aboveIndication and doseSee notes aboveNicorette c (McNeil)Tablets (sublingual) (Nicorette Microtab c ), nicotine(as a cyclodextrin complex) 2 mg, net price starterpack of 2 15-tablet discs with dispenser = £4.46;pack of 100 = £12.12. Label: 26, counselling,administration, see notes aboveNote Also available as NicAssist cExcipients lemon flavour includes aspartame (section 9.4.1)Chewing gum, sugar-free, nicotine (as resin) 2 mg, netprice pack of 30 = £3.41, pack of 105 = £9.37, pack of210 = £14.82; 4 mg, pack of 30 = £3.99, pack of 105 =£11.48, pack of 210 = £18.24. Counselling, administration,see notes aboveNote Available in mint, freshfruit, freshmint, and icy whiteflavours (icy white flavour not available for pack size of 210pieces). Also available as NicAssist cMint lozenge, sugar-free, nicotine (as bitartrate) 2 mg,net price pack of 24 = £2.55, pack of 96 = £8.29.Label: 24, counselling, administration, see notesabovePatches, self-adhesive, beige, nicotine, ‘5 mg’ patch(releasing approx. 5 mg/16 hours), net price 7 = £9.07;‘10 mg’ patch (releasing approx. 10 mg/16 hours), 7 =£9.07; ‘15 mg’ patch (releasing approx. 15 mg/16hours), 2 = £2.85, 7 = £9.07. Counselling, administration,see notes aboveNote Also available as NicAssist cInvisi patches, self-adhesive, beige, nicotine, ‘10 mg’patch (releasing approx. 10 mg/16 hours), net price 7= £9.97; ‘15 mg’ patch (releasing approx. 15 mg/16hours), 7 = £9.97; ‘25 mg’ patch (releasing approx.25 mg/16 hours), 7 = £9.97. Counselling, administration,see notes aboveOral spray (Nicorette Quickmist c mouthspray),nicotine 1 mg/metered dose, net price 150-dose pack