Tobacco cessation fall 2011 Instructor (1)_ For use in lecture (3)

Treatment day dose day 1 to day 3 0.5 mg qd day 4 to

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Unformatted text preview: Treatment Day Dose Day 1 to day 3 0.5 mg qd Day 4 to day 7 0.5 mg bid Day 8 to end of treatment* 1 mg bid Initial dose titration * Up to 12 weeks VARENICLINE: ADVERSE EFFECTS Common (≥5% and 2-fold higher than placebo) Nausea Sleep disturbances (insomnia, abnormal dreams) Constipation Flatulence Vomiting VARENICLINE: ADDITIONAL PATIENT EDUCATION Doses should be taken after eating, with a full glass of water Nausea and insomnia are side effects that are usually temporary If symptoms persist, notify your health care provider Dose tapering not necessary when discontinuing treatment Stop taking varenicline and contact a health-care provider immediately if agitation, depressed mood, suicidal thoughts or changes in behavior are noted VARENICLINE: SUMMARY DISADVANTAGES May induce nausea in up to one third of patients. Post-marketing surveillance data indicate potential for neuropsychiatric symptoms. ADVANTAGES Easy to use oral formulation. Twice daily dosing might reduce compliance problems. Offers a new mechanism of action for persons who have failed other agents. LONG-TERM ( ≥ 6 month) QUIT RATES for AVAILABLE CESSATION MEDICATIONS 5 10 15 20 25 30 Nicotine gum Nicotine patch Nicotine lozenge Nicotine nasal spray Nicotine inhaler Bupropion Varenicline Active drug Placebo Data adapted from Cahill et al. (2008). Cochrane Database Syst Rev; Stead et al. (2008). Cochrane Database Syst Rev; Hughes et al. (2007). Cochrane Database Syst Rev Percent quit 18.0 15.8 11.3 9.9 16.1 8.1 23.9 11.8 17.1 9.1 19.0 10.3 11.2 20.2 COMBINATION PHARMACOTHERAPY Combination NRT Long-acting formulation (patch) Produces relatively constant levels of nicotine PLUS Short-acting formulation (gum, inhaler, nasal spray) Allows for acute dose titration as needed for nicotine withdrawal symptoms Bupropion SR + Nicotine Patch Regimens with enough evidence to be ‘recommended’ first-line COMPLIANCE IS KEY to QUITTING Promote compliance with prescribed regimens. Use according to dosing schedule, NOT as needed. Consider telling the patient: “When you use a cessation product it is important to read all the directions thoroughly before using the product. The products work best in alleviating withdrawal symptoms when used correctly, and according to the recommended dosing schedule.” $0 $1 $2 $3 $4 $5 $6 $7 $8 Trade $6.58 $5.26 $3.89 $5.29 $3.72 $7.40 $4.75 Generic $3.28 $3.66 $1.90-- $3.62- Gum Lozenge Patch Inhaler Nasal spray Bupropion SR Varenicline COMPARATIVE DAILY COSTS of PHARMACOTHERAPY $/day Average $/pack of cigarettes, $4.32 SUMMARY To maximize success, interventions should include counseling and one or more medications...
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Tobacco cessation fall 2011 Instructor (1)_ For use in lecture (3)

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