• Encouraging tobacco users making a quit attempt to use OTC medications, except in the presence of special circumstances.
  
  
• Providing people with instructions on appropriate use of OTC medications.
  
  
• Encouraging people to use OTC medications in combination with behavioral therapy.
  
  
• Providing counseling and follow-up with people using OTC medications.
  
  
• Advising people using OTC medications to read the product instructions and consult with a pharmacist if they don't understand something.

The Public Health Service Guideline indicates that OTC medications are most effective for the treatment of nicotine dependence when combined with behavioral treatment.
 

Nicotine Gum (or Nicotine Polacrilex)

Nicotine gum was first approved by the FDA in 1984 and became available without a prescription in 1996. A person will need to stop using tobacco completely before using the nicotine gum.

Before advising tobacco users to quit with the nicotine gum, review the Treatment Specialist's role. In addition, review the health professional's responsibilities for advising people to quit with Over-The-Counter medications and instructions for use of this form of NRT. For more information go to http://patienteducation.upmc.com/Pdf/NicotineGum.pdf.

Presentation

The gum is available in 2 mg and 4 mg (per piece) strengths.

Availability

Brand names:    Nicorette (2 or 4 mg per piece)
                        Other brands are also available in varied dosages

• 2 mg (< 24 pieces/day) for people smoking < 25 cigarettes/day.

• 4 mg (< 24 pieces/day) for people smoking > 25 cigarettes/day.

• Use on a fixed schedule (at least one piece every 1-2 hours) for 4-12 weeks.
  

Efficacy

Odds ratio 1.5 (nicotine gum : placebo)

Meta-analysis data show that in placebo-controlled double-blind studies, tobacco users were 1.5 times more likely to quit successfully using the nicotine gum (Fiore et al., 2000).

Precautions

Tobacco users in any of the special circumstances groups should consult with a physician before using the nicotine gum.

Common side effects of nicotine chewing gum include:

• Mouth soreness
• Hiccups
• Indigestion
• Jaw ache

These effects are generally mild, don't last, and often can be alleviated by correcting the chewing technique. People who experience severe mouth soreness or jaw ache while chewing the gum should stop and consult a physician.

People who experience symptoms of nicotine overdose while chewing the gum should stop and talk to a physician. The symptoms of nicotine overdose include:

• Nausea
• Vomiting
• Dizziness
• Weakness
• Rapid heartbeat

Instructions for use

The gum should be chewed slowly until a "peppery" or "minty" taste emerges, then "parked" between the cheek and gum to facilitate nicotine absorption.  After the taste has faded, the same gum should be chewed again until the taste returns. The gum should be "chewed and parked" until all the taste is gone (about 30 min.). Only one piece of gum should be chewed at a time.

The gum should not be chewed too fast, as that will release more nicotine and possibly cause unpleasant side effects. The nicotine in the gum is absorbed through the lining of the mouth; therefore, swallowing the nicotine in the saliva is not helpful. Eating and drinking anything (except water) should be avoided 15 minutes before and during chewing because food and beverages interfere with nicotine absorption.

Cost/day

$6.25 for ten, 2 mg pieces
$6.87 for ten, 4 mg pieces
(Fiore et al., 2000)