Nicotine(nik’ oh teen)
Nicoderm CQ, Nicoderm Transdermal System, Nicotrol, Nicotrol Inhaler, Nicotrol NS
PREGNANCY CATEGORY D
Drug class
Smoking deterrent
Therapeutic Actions
Nicotine acts at nicotinic receptors in the peripheral and CNS; produces behavioral stimulation and depression, cardiac acceleration, peripheral vasoconstriction, and elevated BP.
Indications
Temporary aid to the cigarette smoker seeking to give up smoking while in a behavioral modification program under medical supervision
Unlabeled use: Improvement of symptoms of Tourette syndrome
Contraindications and Cautions
Contraindicated with allergy to nicotine, arrhythmias, angina pectoris, pregnancy, lactation, and during the post-MI period. Inhaler is contraindicated with asthma, COPD.
Use cautiously with hyperthyroidism, pheo-chromocytoma, type 2 diabetes (releases catecholamines from the adrenal medulla), hypertension, peptic ulcer disease.
Available Forms
Transdermal system—7, 14, 21 mg/day; 5, 10, 15 mg/16 hr (Nicotrol); nasal spray—0.5 mg/actuation (10 mg/mL); inhaler—4 mg/actuation
Dosages
Adults
Topical
Apply system, 5–21 mg, once every 24 hr. Dosage is based on response and stage of withdrawal. Nicoderm: 21 mg/day for first 6 wk; 14 mg/day for next 2 wk; 7 mg/day for next 2 wk. Nicotrol: 15 mg/day for first 6 wk; 10 mg/day for next 2 wk; 5 mg/day for last 2 wk.
Nasal spray
1 spray in each nostril as needed, one to two doses each hour, up to five doses/hr and 40 doses/day.
Nasal inhaler
1 spray in each nostril, one to two doses/hr to a maximum five doses/hr or 40 doses/day. Dosage is individualized; in studies, best results were achieved by continuous, frequent puffing over 20 min. Do not use longer than 6 mo. Patients are treated for 12 wk, then weaned off the daily dose over next 6–12 wk.
Pediatric patients
Safety and efficacy in children and adolescents who smoke have not been established.
