“Starting now, you must give up smoking completely. Gradually cutting down your tobacco consumption will not work.” This is the unusually harsh language on the package insert of a chewing gum now available to aid smokers’ efforts to stop. The habituating power of smoking is real. As proof of its strong psychological effect, the American Psychiatric Association recently classified tobacco dependence as an addiction and an organic mental disorder.
The physical dangers of smoking are, equally real. It’s strongly linked to nearly all of the top 10 causes of death in the United States. But “scare tactics,” awareness of the dangers, and even a strong desire to quit are not always enough to help patients stop smoking. Patient compliance, both in using the chewing gum and in efforts to give up cigarettes, is essential to success.
Indications. The sugarless gum, which contains 2 mg of nicotine, is intended to minimize the effects of nicotine withdrawal while the smoker tries to give up a strong and complexly rewarding habit. Because nicotine is absorbed more slowly with the gum and doesn’t produce the “peak” effects associated with smoking, the smoker will feel less gratified by nicotine’s effects, which calm him when he’s anxious and energize him when he needs it. $TBy modulating these physical effects, the smoker can wean himself of the smoking habit without risking the craving and irritability that abrupt withdrawal has been known to bring.
The prescription drug is marketed under the trade name Nicorette by Merrell Dow. Patients are instructed to chew one piece slowly and intermittently for about 30 minutes every time they have an urge to smoke. But they are instructed to limit their use to 30 pieces per day. The benefits of using the drug for longer than three months haven’t been proven.
Precautions. The drug is contraindicated in women who are or may become pregnant since nicotine is a teratogen. It’s also prohibited for patients with serious arrhythmias, vasospastic disease, active temporomandibular disease, or patients in the immediate post-MI period and/or those who have angina pectoris.
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The drug should also be used with caution in patients with hyperthyroidism, pheochromocytoma, hypertension, insulin-dependent diabetes, oral or pharyngeal inflammation, or a history of esophagitis or peptic ulcer.
The drug may alter serum levels or metabolism of other drugs, such as phenacetin, caffeine, theophylline, imipramine, pentazocine, glutethimide, and propoxyphene. It may also alter the effects of furosemide and propranolol.
Adverse reactions. Some patients have experienced systemic reactions during clinical trials. These include insomnia, irritability, headache, nonspecific GI distress, eructation, indigestion, anorexia, hiccups, nausea and vomiting, and dizziness and light-headedness. The patient may also experience local effects on the jaw and mucosa.
Nursing implications. The manufacturer acknowledges that many smokers who try to quit eventually start smoking again. The package insert warns patients, “Remember to carry the gum with you at all times in case you get the urge to smoke again. Do not forget that one cigarette is enough to start you on the smoking habit again.”
Since nicotine is an extremely powerful drug in its pure form, there is also a warning of the possibility of overdose, or potentially dangerous ingestion by children. In either case, contact the local Poison Control Center for assistance. Induce emesis in conscious patients; secure the airway in unconscious patients first, and then perform gastric lavage with activated charcoal. Cardiovascular and respiratory failure should be treated symptomatically.