Smoking Cessation Guide (part 2)

Please find the attached circular about smoking cessation guide part 2 .Please read it carefully and keep it in your pharmacy files as a reference.

10/5/2020
Drug information center
Rania Dahnous
 The pharmacological treatments for Smoking Cessation include:

Brand Active Dosing Administration Common Side Notes

Name Ingredient Effects

Nicorette More than 10 cigarettes per day:  Apply to clean, dry, 1. Skin irritation  The patch has a long-acting, slow-
invisi hairless, healthy skin on 2. Insomnia and onset pattern of nicotine delivery,
Step 1 contains 25 mg of nicotine
patch® the front or side of the vivid dreams producing relatively constant
Long acting and it is used for 8 weeks.
chest, upper arm or hip. when the patch withdrawal relief over 24 hours, but
(Currently Nicotine is left on
Step 2 contains 15 mg of nicotine  Do not apply the patches requiring several hours to reach peak
not Replacement and it is used for 2 weeks. overnight (can
to broken, red or levels.
available) Therapy (NRT) be minimized by 
Step 3 contains 10 mg of nicotine irritated skin. If you exercise while wearing a nicotine
 Don’t apply oils or removing the patch the amount of nicotine absorbed
and it is used for 2 weeks.
talcum powder to the patch at into your bloodstream may increase,
skin before applying the bedtime). which could increase the side effects of
Less than 10 cigarettes per day: patch, as they will nicotine.
prevent it sticking  Patients who remove the patch at night
Start with step 2 immediately for
properly. and experience morning cravings for
8 weeks then step 3 for additional
 The patches must not be nicotine can use a short-acting form of
4 weeks.
cut. nicotine replacement therapy (Gum)
 Patch site should be while waiting for the nicotine patch to
rotated daily to avoid take effect (it needs 0.5-3 hours after
skin irritation. reapplication to reach the effective
levels).
 Compliance level with nicotine patch is
high.
Nicorette Short acting More than 20 cigarettes per day: Use the "chew and park" 1. Nausea  Chewing the gum releases nicotine that
Gum® Nicotine method: 2. Vomiting is absorbed through the oral mucosa,
One 4 mg gum as required to 3. Abdominal pain resulting in a peak of blood nicotine
Replacement
relieve cravings. 1. Chew Nicorette Gum 4. Constipation levels 20 minutes after starting to
Therapy (NRT)
slowly until you can 5. Hiccups chew.
 20 cigarettes or fewer per day:
One 2 mg gum as required to
relieve cravings.
 Use only one piece of gum at a
time.
 Do not use more than 15 gums
per day.
 Chew 1 piece every 1-2
hours for the first 6 weeks of
your quit.
 Be sure to use at least 9 pieces 5.
of Nicorette a day for the first
6 weeks of your quit.
1. Champix® Varenicline (a Day 1 – 3:
2. partial agonist
From day 1 to day 3, you should
3. V Quit® at the nicotinic
take one white Champix®/ V
acetylcholine
Quit® 0.5 mg film-coated tablet
receptor)
once a day.
Day 4 – 7:
From day 4 to day 7, you should
take one white Champix®/ V
Quit® 0.5 mg film-coated tablet
twice daily, once in the morning
and once in the evening, at about
taste the nicotine or feel 6. Headache  Don’t eat or drink 15 minutes before
a tingling sensation in 7. Excess or while you’re chewing Nicorette.
your mouth. salivation  Acidic beverages (coffee, carbonated
2. Stop chewing and park 8. A sore jaw drinks) should be avoided before and
the piece of Nicorette 9. Mouth irritation during gum use, as acidic beverages
between your cheek and or ulcers lowers oral pH, causing nicotine to
gums. ionize and reducing nicotine
3. After about a minute, absorption.
when the tingling is
almost gone, start
chewing again.
4. Repeat this process until
the tingle is gone (about
30 minutes).
If you experience strong
or frequent cravings, you
can chew a second piece
of nicotine gum within
the hour.
 The tablets should be 1. Inflammation of  Varenicline aids in smoking cessation
swallowed whole with the nose and in two ways:
throat
water and can be taken 1. As a partial agonist, it binds to and
with or without food at 2. Abnormal produces partial stimulation of the
the same time each day. dreams nicotinic receptor, thereby reducing
 Advice the patient to 3. Difficulty the symptoms of nicotine withdrawal.
take it after eating and sleeping 2. It blocks the nicotine in tobacco smoke
with a full glass of water 4. Headache from binding to nicotinic receptor,
to decrease gastric 5. Nausea thereby reducing the rewarding
upset. aspects of cigarette smoking.
 Before starting the course of Champix
the patient should usually decide on a
date in the second week of treatment
(between day 8 and day 14) when
he/she will stop smoking.
 the same time each day.
Day 8 – End of treatment (12
weeks):
From day 8 to day 14, you should
take one light blue Champix®/ V
Quit® 1 mg film-coated tablet
twice daily, once in the morning
and once in the evening, at about
the same time each day.
NicoBloc® Water, Week 1:
Sugar Compoun
Apply one drop on each cigarette
d (Corn syrup),
smoked.
and Citric Acid
Week 2:
Apply 2 drops on each cigarette
smoked.
Week 3- end of treatment (week
6):
Apply 3 drops on each cigarette
1. Apply NicoBloc to the
filter just prior to
smoking.
2. Make a small indention
in the filter with the tip
of the bottle and apply
one drop.
3. Gently cover the entire
filter tip using the bottle
tip to move it around.
4. Squeeze the filter a few
times to help the filter
absorb the fluid.
 Light the cigarette. Take
 If he is not willing or able to set a target
quit date within 2 weeks, he/she may
choose his own target quit date within
5 weeks after starting treatment.
 Avoid driving and doing other tasks or
actions that call for you to be alert or
have clear eyesight until you see how
this drug affects you.
 Varenicline should be discontinued
immediately if you are concerned
about agitation,
depressed moods changes in your
behavior, or if you develop suicidal
thoughts or behavior.
 Refer to the doctor if the patient
suffers from chronic diseases,
especially cardiovascular diseases,
Psychiatric illness, renal impairment,
Seizures.
 Nicobloc works by trapping the
nicotine and tar in the filter of the
cigarette. One drop traps up to 33%,
two drops 66% and three drops up to
99%.
 NicoBloc can be used by all smokers
including pregnant, diabetics,
etc. because it's not a drug, nor it is
consumed by the smoker.
 NicoBloc does not make cigarettes safe
only less harmful.
 One bottle of NicoBloc will last the
average smoker (20 cigarettes per day)
about 2 weeks. Therefore 3 bottles will
last 6 weeks or the recommended
amount of time it takes to quit.
 smoked. a hard first draw, and ‫ المدخن الذي يقوم‬NicoBloc ‫تكفي العلبة الواحدة من‬
then smoke as usual. ‫ سيجارة في اليوم مدة أسبوعين‬02 ‫بتدخين ما يعادل‬
 When applying 2 drops .‫تقريبا‬
in week 2, or 3 drops in ‫ علب لتغطية مقدار الوقت‬3 ‫سيحتاج المدخن تقريبا إلى‬
week 3, repeat steps 2- .)‫ أسابيع‬6( ‫الموصى به لإلقالع عن التدخين‬
4, allowing the fluid to
fully soak in to the filter,  NicoBloc has a slight sweet taste
between applying (which not everybody can detect) but
drops. does not change the taste of the
cigarette.

Frequently asked questions:

Are electronic-cigarettes (e-cigs, vapes) less harmful than regular cigarettes?

 Yes—but that doesn’t mean e-cigarettes are safe.
 E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes. However, e-
cigarette aerosol is not harmless. It can contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic
compounds, and cancer-causing agents.
 E-cigarettes have the potential to benefit adult smokers who are not pregnant if used as a complete substitute for regular cigarettes and other smoked
tobacco products.
 E-cigarettes are not safe for youth, young adults, and pregnant women, as well as adults who do not currently use tobacco products.

‫ لذلك يمكن اعتبار السيجارة‬,‫ مادة سامة في السيجارة الواحدة‬0777 ‫ التي تحتوي على خليط من‬,‫تحتوي السيجارة اإللكترونية على عدد أقل من المواد السامة بالمقارنة مع السيجارة العادية‬
.‫ و ال ننصح باستخدامها‬.‫اإللكترونية أقل ضررا من السيجارة العادية و لكن ذلك ال يعني أنها آمنة تماما لالستخدام‬

Are there any smoking cessation clinics in Jordan?

 Ministry of Health (‫ وزارة الصحه‬- ‫)مركز االقالع عن التدخين‬
 Smoking Cessation Clinic at King Hussein Cancer Center (KHCC)
 Smoking cessation clinic at JUH (‫)عيادة اإلقالع عن التدخين في مستشفى الجامعة األردنية‬

Are there any other smoking cessation treatments in Jordan?

Bupropion and Nicorette inhaler® may be found in KHCC.