Pharmacological Treatment
Bupropion Hydrochloride
Fluoxetine
Nicotine Products
Lobeline (Bantron)
Summary
The following information is based on the successful use of pharmacological
agents in the cessation of smoking in the general population. None of the
following agents have been studied in large placebo-controlled studies in
cancer patients for aid in smoking cessation. Dosage adjustments or titrations may be required when administering these agents
to oncology patients.
Bupropion Hydrochloride
Also used as an antidepressant, bupropion hydrochloride (HCl) (Zyban) is a nonnicotine aid to smoking cessation. It is a relatively weak inhibitor of the neuronal uptake of norepinephrine, serotonin, and dopamine and does not inhibit monoamine oxidase. The exact mechanism by which bupropion HCl enhances the ability of patients to abstain from smoking is unknown; however, it is presumed that this action is mediated by noradrenergic or dopaminergic mechanisms.[1] One study [2] failed to find any additional value of bupropion HCl in reducing relapse in individuals using the nicotine patch compared with a placebo either as part of a relapse prevention program (after the end of successful patch therapy) or as a second-level treatment for individuals who were still smoking after nicotine-patch therapy.
Bupropion HCl
|
Brand
|
Dose
|
Side Effects
|
Warning/precaution
|
Rx = prescription.
|
Rx |
Zyban |
150 mg/day × 3 days then increase to 300 mg/day × 7–12 weeks |
Insomnia, dry mouth, dizziness, rhinitis |
Do not take with Wellbutrin or Wellbutrin SR. |
Higher incidence of seizures in patients treated for bulimia or anorexia. |
Do not prescribe >300 mg/day for patients being treated for bulimia. |
Fluoxetine
Although bupropion HCl (Zyban) is the only U.S. Food and Drug Administration (FDA)-approved antidepressant for smoking cessation, fluoxetine HCl (Prozac)
has recently been studied and shown to be effective.[1]
Fluoxetine HCl
|
Brand
|
Dose
|
Side Effects
|
Comments
|
Rx = prescription.
|
Rx |
Prozac |
30–60 mg/day |
Insomnia, dizziness, anorexia, sexual dysfunction, confusion |
Limited data available on its use in combination with cognitive-behavioral therapy. |
Nicotine Products
These products are designed to aid in the withdrawal
symptoms associated with nicotine. Several precautions must be considered
before initiating therapy, but these precautions do
not constitute absolute contraindications.
- Patients who are pregnant or nursing should obtain advice from a
health care professional before using these products.
- Patients should be advised to not use these products if they continue to
smoke, chew tobacco, use snuff, or use other nicotine-containing products.
- Patients should be instructed to consult a physician before using these
products if they are younger than 18 years, have heart disease or an
irregular heartbeat, have high blood pressure not controlled by
medication, have a history of or currently have esophagitis or peptic-ulcer
disease, use insulin for diabetes, or take prescription medications for
depression or asthma.[3]
Nicotine Inhalers
|
Brand
|
Dose
|
Side Effects
|
Comments
|
Rx = prescription.
|
Rx |
Nicotrol NS |
Max 40 mg/day |
Local irritation |
Max use 3 months. |
Rx |
Nicotrol Inhaler |
Individualized |
Local irritation |
Use up to 24 weeks. |
Nicotine Polacrilex Gums
|
Brand
|
Dose
|
Side Effects
|
Comments
|
OTC = over the counter.
|
OTC |
Nicorette |
18–24 mg/day |
Sore throat, stomatitis |
Max 30 pieces/day; decrease 1 piece every 4–7 days. |
OTC |
Nicorette DS |
36–48 mg/day |
Jaw ache |
Max 20 pieces/day; decrease 1 piece every 4–7 days. |
Nicotine Lozenges
|
Brand
|
Dose
|
Side Effects
|
Comments
|
OTC = over the counter.
|
OTC |
Commit |
40–80 mg/day |
Local irritation (warmth and tingling) |
Use for 12 weeks; max 20 pieces/day. Weeks 1–6: 1–2 lozenges every 1–2 hours; weeks 7–9: 1 lozenge every 2–4 hours; weeks 10–12: 1 lozenge every 4–8 hours. |
Nicotine Patches
|
Brand
|
Dose
|
Side Effects
|
Comments
|
OTC = over the counter; Rx = prescription.
|
Rx |
Habitrol |
7–21 mg/day |
Erythema |
Use for 6–12 weeks. |
OTC |
Nicoderm CQ |
7–21 mg/day |
Pruritus |
Use for 6–12 weeks. |
OTC |
Nicotrol |
5–15 mg/day |
Burning at site |
Use for 14–20 weeks. |
Rx |
ProStep |
11–22 mg/day |
Local irritation |
Use for 6–12 weeks. |
Lobeline (Bantron)
Lobeline (Bantron) is classified as a category III agent by the FDA (safe but
no proven effectiveness). This product is not recommended for use in any
smoking cessation program because of its lack of efficacy.[4]
Summary
- Continued smoking substantially increases the likelihood of recurrence or
occurrence of a second cancer in survivors, particularly in those who
received radiation therapy.
- Most patients with smoking-related cancer appear motivated to
quit smoking at the time of diagnosis.
- A stepped-care approach is recommended, with strong physician advice and
brief counseling to quit and provision of basic information to all
patients at each contact during the first month of diagnosis, followed by
more intensive treatment (pharmacologic and counseling by a smoking
specialist) for those having difficulty quitting or remaining abstinent.
References
-
Hitsman B, Pingitore R, Spring B, et al.: Antidepressant pharmacotherapy helps some cigarette smokers more than others. J Consult Clin Psychol 67 (4): 547-54, 1999.
[PUBMED Abstract]
-
Hurt RD, Krook JE, Croghan IT, et al.: Nicotine patch therapy based on smoking rate followed by bupropion for prevention of relapse to smoking. J Clin Oncol 21 (5): 914-20, 2003.
[PUBMED Abstract]
-
Fincham JE: Smoking cessation products. In: Covington TR, Berardi RR, Young LL, et al., eds.: Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996, pp 715-723.
-
Drug Facts and Comparisons. St. Louis, Mo: Facts and Comparisons, 1998.
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