Nicotine Lozenge.

Description: 
See FDA package insert for more complete information.

The nicotine lozenge is currently marketed over the counter under the name Commit®. It is sold over the counter in 2- or 4-mg doses. There are 72 lozenges to a package.

Description

The nicotine lozenge is currently marketed over the counter under the name Commit®. It is sold over the counter in 2- or 4-mg doses. There are 72 lozenges to a package.

How Well Does It Work?

Long term abstinence rates for the lozenge are approximately doubled in comparison to the placebo, with the 4mg dose being a little more effective than the 2 mg dose.

Warnings

Precautions and Contraindications

  • Pregnant or nursing women: If you are pregnant or nursing, you should consult your doctor. Pregnant women are encouraged to quit without medication. It is most important that you quit smoking. The nicotine inhaler has not been shown to be effective in treating tobacco dependence in pregnant smokers and it has not been evaluated in breastfeeding patients. The risks of such drugs to unborn children are not fully known. Seeking intensive counseling support in your quit attempt is a good idea.

  • Cardiovascular disease: Nicotine replacement therapies (NRTs), such as nicotine lozenges, have not been proven to increase the risk of having a heart attack, but should be used with caution in people who have had a heart attack within 2 weeks. The gum also might not be right for you if you have a history of coronary heart disease, serious arrhythmias, or vasospastic diseases.

  • The lozenge should not be chewed or swallowed. This can cause heartburn and indigestion, and the nicotine content will not be properly absorbed from the stomach.

  • The lozenge should be used with caution in patients with hypertension, stomach ulcers, or diabetes.

  • If you are taking prescription drugs for asthma or depression, a doctor should be consulted before taking the lozenge.

  • Patients using the lozenge should not eat or drink 15 minutes before or while the lozenge is in the mouth. Acidic foods and drinks in particular should be avoided.

  • The lozenge should not be used if a patient is currently smoking or chewing tobacco or if any other form of nicotine replacement therapy is being used.

Side Effects

  • Mouth pain
  • Hiccups
  • Coughing
  • Heartburn
  • Sore throat
  • Headache
  • Indigestion
  • Nausea
  • Insomnia
  • Irregular heartbeat

How Do I Take This Medication?

  • You should let the lozenge slowly dissolve in the mouth, occasionally switching it from one side of the mouth to the other. The lozenge should dissolve completely in approximately 20 to 30 minutes. Swallowing the lozenge should be avoided.

  • Dosage should be selected depending on when a patient has his or her first cigarette of the day. A 4-mg lozenge should be taken by those who have their first cigarette within 30 minutes of waking, and the 2-mg lozenge should be taken by those who have their first cigarette later than 30 minutes after waking.

  • No more than 1 lozenge should be taken at a time, and no more than 5 lozenges should be taken in a 6-hour period.

  • Follow a 12-week quitting schedule. For the first 6 weeks, take 1 lozenge every 1 to 2 hours, no fewer than 9 per day, but no more than 20 per day. Use no more than 20 lozenges per day; use lozenges up to 12 weeks. Talk to your doctor if cravings continue.

(GlaxoSmithKline, 2002; Fiore et al, 2008; Commit Lozenge, 2002; Nicotine Lozenge, 2002; Shiffman et al., 2002)

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