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Quick Guide to Pharmacotherapy in Tobacco Treatment NICOTINE REPLACEMENT (NRT)
Combining long-acting NRT (patch) with a short-acting NRT (gum, lozenge, or inhaler) is more effective than using a single type of NRT
LONG-ACTING PRODUCTS
PATCH
7 mg, 14 mg, 21 mg Dose: 1 patch every 24 hrs. SHORT-ACTING PRODUCTS
GUM
LOZENGE or MINI-LOZENGE
NASAL SPRAY (Nicotrol® NS)
INHALER (Nicotrol® Inhaler)
BUPROPION SR (Zyban®/ Wellbutrin SR®)
May be combined with nicotine replacement150 mg tablets Dose: 150 mg once per day (days 1-3) Duration: VARENICLINE (Chantix®)
0.5 mg, 1 mg tablets Dose: Starting Month Pack =
Continuing Month Pack = 1 mg twice per day * If quit at 12 wks, consider 12 more weeks of drug Source: Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Quick Reference Guide for Clinicians, Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. April 2009. Inclusion of this adult dosage chart is strictly for the convenience of the prescribing provider. Please consult the Physicians’ Desk Reference for complete product information and contraindications. This chart does not indicate or authorize insurance benefit coverage for any of these medications. This chart is provided by the Massachusetts Department of Public Health’s Tobacco Cessation 5A Tobacco Intervention
ASK ABOUT TOBACCO USE AT EVERY VISIT
 Implement an office system that ensures that, for every patient at every visit,
tobacco-use status is queried and documented.
ADVISE ALL TOBACCO USERS TO QUIT
 “I strongly advise you to quit smoking and I can help you.”
ASSESS READINESS TO QUIT
 Ask every tobacco user if s/he is willing to make a quit attempt at this time:
• If willing to quit, provide assistance (see below).
• If unwilling to quit, provide motivational intervention.
ASSIST TOBACCO USERS IN QUITTING
 Provide brief counseling:
 Recommend use of combination or single pharmacotherapy (patch, gum, lozenge, nasal spray, inhaler, bupropion, or varenicline) unless contraindicated.
 Be aware of insurance coverage. MassHealth covers all FDA-approved medications. Many health plans cover some or all medications.
 Provide supplementary educational materials.
ARRANGE FOLLOW-UP
 Refer to QuitWorks: fax consent signed by patient to 1-866-560-9113 for
proactive call to assess and arrange treatment.
 At subsequent visit, review patient follow-up report from QuitWorks. Congratulate success, encourage maintenance.
• Ask for recommitment to total abstinence • Review circumstances that caused lapse • Assess pharmacotherapy use and problems.
 Consider referral to more intensive treatment.
For More Information:
1-800-QUIT-NOW (1-800-784-8669)
Visit www.quitworks.org
Make smoking history.

Source: http://quitworks.makesmokinghistory.org/uploads/Pharma_Guide2.pdf