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Smoking
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Jorge E. Tolosa, Niyazi Kilic, David M. Stamilio
Nicotine patchFDA classifies it as a drug with known human risk in pregnancy.Nicotine patches during pregnancy have been associated with nonsignificant effects on smoking cessation in pregnant smokers [63, 64, 66, 67]. Multiple meta-analyses of studies on other nicotine replacement therapies in pregnancy indicate that there is insufficient evidence that NRT (mostly patch) is effective or safe in prenatal smoking cessation [52, 68, 69]. Myung et al. concluded that there is a 13% mean abstinence rate in their meta-analysis; they included seven studies of which one is s a prospective study of bupropion, one is a quasi RCT that studied use of a multimodal intervention, and the other five were RCTs of NRT that did not show an effect [69]. Adding a nicotine patch (15 mg per 16 hours) to behavioral cessation support for women who smoked during pregnancy did not significantly increase the rate of abstinence from smoking until delivery or the risk of adverse pregnancy or birth outcomes [65]. No significant effect on birth-weight or preterm birth were associated with nicotine patch use [61, 63, 67].
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
In a double-blind study involving 183 smokers, of 7 patients who had a papulovesicular rash to nicotine TTS, 6 were patch tested with a nicotine TTS, a placebo TTS (without nicotine), matrix material, and gauze. Five of these patients had positive patch test reactions to the nicotine patch but not the placebo patch and they were diagnosed with contact allergy to nicotine (2).
Substance Abuse and Addiction
Published in James M. Rippe, Manual of Lifestyle Medicine, 2021
Pharmacological aids for smoking cessation include seven medications which are approved by the U.S. Food and Drug Administration (FDA). These include over-the-counter products (nicotine gum, nicotine lozenge, and the nicotine patch) and prescription-only medications (nicotine nasal spray, nicotine inhaler, sustained release bupropion, and varenicline) (8). These nicotine replacement therapies can significantly reduce nicotine withdrawal and have been shown to increase the rate of quitting by 50–70%.
Exploring the Role of Traumatic Event Exposure in Tobacco Dependence Treatment Outcomes Among African Americans
Published in Journal of Psychoactive Drugs, 2021
A. Shevorykin, L. M. Ruglass, A. D. Mancini, E. Carl, A. Legg, C. E. Sheffer
Weekly group treatment sessions were conducted by clinical psychologists who were certified Tobacco Treatment Specialists trained by an accredited training program (www.ctttp.org). The standard treatment was a manual-driven multicomponent cognitive-behavioral therapy for tobacco dependence, consisting of education and activities aimed at increasing participants’ understanding of the biopsychosocial underpinnings of tobacco dependence and the cue–urge–response cycle of smoking. Sessions included training on treatment goal setting, stress management, strategies for managing cravings and cues, self-monitoring, problem solving, conflict management, scheduled rate reduction, medication reduction, cigarette refusal, relapse prevention, and enhancing social support. The adapted treatment was a modified version of the standard treatment, with adaptation based on several frameworks designed to adapt evidence-based treatments for disparate groups, increase community engagement, and incorporate African American values and experiences into health programming. The adapted treatment maintained the same amount of treatment contact, while increasing emphasis on stress and negative affect management and fostering internal locus of control, as well as including more examples specifically relevant to lower SES groups and African Americans. See Sheffer et al. (2017) and Evans et al. (2015) for details on the adaptation process. All participants were also provided an 8-week supply of 24-hour nicotine patches (21 mg for 4 weeks, 14 mg for 2 weeks, and 7 mg for 2 weeks) and were expected to initiate use on the morning of the quit day.
Bridging inhaled aerosol dosimetry to physiologically based pharmacokinetic modeling for toxicological assessment: nicotine delivery systems and beyond
Published in Critical Reviews in Toxicology, 2019
A. R. Kolli, A. K. Kuczaj, F. Martin, A. W. Hayes, M. C. Peitsch, J. Hoeng
Nicotine replacement therapy (NRT) aims to reduce the motivation to consume tobacco and the physiological and psychomotor withdrawal symptoms while still delivering nicotine and has been shown to be less harmful than consuming tobacco (Silagy et al. 2004; Prochaska 2015). NRT products are delivered in various forms, including gum, transdermal patch, nasal spray, oral inhaler, and tablet. Transdermal delivery of nicotine via a patch is successful, as the nicotine penetrates rapidly, allowing the delivery of fairly large doses. The nicotine patch is a slow, sustained-release form of nicotine delivery that is intended to gradually lower users’ dependence on tobacco and ultimately eliminate this dependence (Figure 1) (Benowitz et al. 2009). Acute dosing products allow users to titrate the timing and dose of nicotine. Products such as nicotine gum and lozenges are buffered to alkaline pH to facilitate increased absorption. Despite their formulations, NRTs were unable to mimic the plasma concentrations of nicotine following inhalation, as the absorption of nicotine from the buccal cavity is slower, and a portion of the dose is swallowed and subjected to first-pass metabolism (Benowitz et al. 2009). Nicotine nasal spray is absorbed more rapidly than other NRTs but does not reach the maximum nicotine concentration (Cmax) of inhaled nicotine, thus requiring larger doses (Lunell et al. 2000).
Pharmaceutical strategies for smoking cessation during pregnancy
Published in Expert Opinion on Pharmacotherapy, 2018
A longitudinal cohort trial evaluated the effects of the nicotine patch and bupropion on smoking cessation, prematurity, and gestational age in pregnant women in Canada using questionnaires from 1998 to 2009 [32]. There was a lower risk of prematurity in the 316 women who used the nicotine patch compared to the 900 who smoked without medication, aOR: 0.21(CI: 0.13–0.34) and a decreased risk of small gestational age, aOR: 0.61(CI: 0.41–0.90) [32]. These results add to the evidence that NRT use is safer than continued smoking. Self-reported smoking cessation rates were 79% while using the patch and 68% after discontinuing it. Although these self-reported rates were high, recall bias and lack of biochemical verification were limitations. A more accurate description for smoking cessation efficacy comes from randomized controlled trials (RCTs).