NRT COMBO THERAPY
Patient Counselling
Patient Counselling
Combinations of different forms of nicotine therapy have been recommended for patients who smoke many cigarettes per day (between 21-40) or who have tried to quit smoking in the past using a single nicotine replacement therapy but were unsuccessful. Talk to your healthcare provider to make sure that a combination approach is right for you.
Combination nicotine replacement therapy usually involves the nicotine patch combined with the gum. There is a pre-packaged combination available for convenience called Nicorette ComboQuit®, which involves a nicotine patch, in different strengths depending on the stage you are in your program to quit, and the 2 mg gum. As your dependence on nicotine wears off, you progress to a weaker patch and chew fewer pieces of gum.
The Patch
While on combination therapy, report feelings of a very rapid fast heart beat or confusion immediately to your health care provider as these may be serious side effects.
References:
1. Canadian Pharmacists Association. Patient Self-care, First Edition (2002) 97-109.
2. Nicorette ComboQuit Package Website. Accessed on June 7, 2012 at http://www.nicorette.ca/stop-smoking/products/combined.
3. Pipe A. Nicotine Replacement Therapy. Ontario Pharmacists’ Association. Last updated: n/a. Accessed on June 7, 2012.
4. Regier L, Jensen B, Chan W. Smoking cessation pharmacotherapy. RxFiles. Last updated: March 2012. Accessed on June 7, 2012.
5. Sweeney CT, Fant RV, Fagerstrom KO, McGovern JF, Henningfield JE. Combination nicotine replacement therapy for smoking cessation: rationale, efficacy and tolerability. CNS Drugs. 2001;15(6):453-67.
6. Regier L, Jensen B, Chan W. Smoking cessation pharmacotherapy. RxFiles. Last updated: March 2012. Accessed on June 7, 2012.
Combinations of different forms of nicotine therapy have been recommended for patients who smoke many cigarettes per day (between 21-40) or who have tried to quit smoking in the past using a single nicotine replacement therapy but were unsuccessful. Talk to your healthcare provider to make sure that a combination approach is right for you.
Combination nicotine replacement therapy usually involves the nicotine patch combined with the gum. There is a pre-packaged combination available for convenience called Nicorette ComboQuit®, which involves a nicotine patch, in different strengths depending on the stage you are in your program to quit, and the 2 mg gum. As your dependence on nicotine wears off, you progress to a weaker patch and chew fewer pieces of gum.
The Patch
- Stick the patch on a clean, dry, hairless area in the morning and remove the patch at night. The patch should be on for no more than 16 hours in a day.
- Rotate the site that you stick the patch to lower the chance of skin irritation.
- As you progress through quitting smoking, the dosage of nicotine that you receive from your patch will be lowered, allowing you to wean yourself off of nicotine.
- The nicotine from the patch is absorbed through your skin, and it takes a while to reach your system. Be prepared to wait a little while before it reaches your system.
- Skin irritation is the most common side effect from the patch, and changing the skin sites you use can help avoid this problem.
- Talk to your pharmacist or healthcare provider about when to switch from one strength of the patch to the next. Sticking to this schedule will help you stay on the right track to quitting smoking.
- Dispose of the patch safely
- This is a short acting source of nicotine to help you with breakthrough cravings for cigarettes. You can chew a piece of nicotine gum even if you are wearing the patch.
- Chew one piece of 2 mg gum when you have a sudden craving for a cigarette. Chew a maximum of 15 pieces of gum per day.
- The main side effect is stomach upset and a sore jaw.
- Chew the gum, and then park it against the side of your cheek. Repeat this every 1-2 minutes. All of the nicotine should be absorbed after half an hour. Using the correct technique will help avoid stomach upset.
- After 10 weeks, gradually reduce the number of pieces of gum to 1-2 per day, and then discontinue use. Talk to your healthcare provider about a schedule for lowering the number of pieces of gum you use slowly.
- Do not drink acidic drinks such as juice, tea or coffee while you are chewing the gum.
While on combination therapy, report feelings of a very rapid fast heart beat or confusion immediately to your health care provider as these may be serious side effects.
References:
1. Canadian Pharmacists Association. Patient Self-care, First Edition (2002) 97-109.
2. Nicorette ComboQuit Package Website. Accessed on June 7, 2012 at http://www.nicorette.ca/stop-smoking/products/combined.
3. Pipe A. Nicotine Replacement Therapy. Ontario Pharmacists’ Association. Last updated: n/a. Accessed on June 7, 2012.
4. Regier L, Jensen B, Chan W. Smoking cessation pharmacotherapy. RxFiles. Last updated: March 2012. Accessed on June 7, 2012.
5. Sweeney CT, Fant RV, Fagerstrom KO, McGovern JF, Henningfield JE. Combination nicotine replacement therapy for smoking cessation: rationale, efficacy and tolerability. CNS Drugs. 2001;15(6):453-67.
6. Regier L, Jensen B, Chan W. Smoking cessation pharmacotherapy. RxFiles. Last updated: March 2012. Accessed on June 7, 2012.