Nicotine lozenge is a nicotine-containing hard lozenge. It is a form of nicotine replacement therapy for smoking cessation that delivers nicotine through the oral mucosa.
Nicotine lozenges are dissoluble tablets that release therapeutic doses of nicotine when placed into the mouth and allowed to dissolve. They should not be chewed or swallowed whole. Users are typically directed place a lozenge in the mouth and allow it to dissolve while perioidically alternating placement to each side of the mouth.
Clinical use of the nicotine lozenge (FDA approved)
| 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 breastfeeding
patients. Because the lozenge was approved as an OTC 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, and the 4-mg
lozenge is recommended for patients who smoke their first cigarette
within 30 minutes of waking. Generally, smokers should use at least
nine lozenges per day in the first 6 weeks; the lozenge should be
used for up to 12 weeks, with no more than 20 lozenges to be used
per day.
|
| Availability |
|
| Prescribing
instructions |
- Lozenge use – The lozenge should be allowed to dissolve in the
mouth rather than chewing or swallowing it.
- Absorption – Acidic beverages (e.g., coffee, juices, soft drinks) interfere
with the buccal absorption of nicotine, so eating and drinking
anything except water should be avoided for 15 minutes before or
during use of the nicotine lozenge.
- Dosing information – Patients often do not use enough prn NRT
medicines to obtain optimal clinical effects. Generally, patients
should use 1 lozenge every 1–2 hours during the first 6 weeks of
treatment, using a minimum of 9 lozenges/day, then decrease lozenge
use to 1 lozenge every 2–4 hours during weeks 7–9, and then
decrease to 1 lozenge every 4–8 hours during weeks 10–12.
|
| Costa |
- 2 mg, 72 lozenges per box = $34 (quantity used determines how
long supply lasts)
- 4 mg, 72 lozenges per box = $39 (quantity used determines how
long supply lasts)
|
| Source: Treating Tobacco Use and Dependence: 2008 Update. (Fiore et al, 2008) |
aCost data were established by averaging the retail price of the medication at national chain pharmacies
in Atlanta, GA, Los Angeles, CA, Milwaukee, WI , Sunnyside, NY, and listed online during
January 2008 and may not reflect discounts available to health plans and others.
References
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
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