nti242d-T3

Table 3: Pharmacological recommendations for active smokers.

Nicotine

replacement

therapy

(NRT)

NRT administration during in-hospital stay in active smokers and/or with high to moderate dependence or withdrawal symptoms regardless the degree of dependency

Consider combination of immediate and long acting NRT if existing high dependence and/or withdrawal syndrome

High nicotine dependence and/or consumption of < 10 cigarettes/day consider: PN 21 mg for six weeks, 14 mg for four weeks, 7 mg for two weeks

Low to moderate dependence and/or consumption < 10 cigarettes/day consider: PN of 14 mg for six weeks and 7 mg for four weeks

Low dependence on nicotine and consumption < 10 cigarettes/day, and/or intolerance to patch consider: Immediate-acting NRT (chewing gum, spray, inhaler or dragees) individual with dosing ad lib/for necessary reason

Immediate-acting NRT (gum or tablet): 4 mg if they smoke their first cigarette in the first 30 minutes after waking up; 2 mg if you smoke your first cigarette after waking up. It is recommended Ad lib schema or according to the manufacturer

NRT prescribing considerations: not recommended in uncontrolled HBP. For oral presentations not recommended if there are oral or pharyngeal lesions, history of radiation therapy to the head and neck, peptic ulcer or UGIB risk.

Oral

therapy

Start treatment based on varenicline, cytisine or bupropion in hospitalized active smokers patients with a high degree of dependence, prolongue use or multiple unsuccessful abandonment attempts

Consider varenicline, cytisine and/or bupropion, in combination with NRT

Varenicline, its dosage will be with tablets: 0.5 mg every 24 hours day 1 to 3, 0.5 mg every 12 hours day 3 to 7 and 1 mg twice daily to complete 12 weeks

In patients with an anxiety and/or depression profile, it is recommended to use NRT of immediate and/or prolonged action in combination with bupropion

Bupropion dosage: 150 mg starting dose the first 3 to 7 days increasing the dose at 150 mg twice daily for 12 weeks

Events to consider in the prescription of bupropion: contraindicate consumption of alcohol, avoid if renal failure, uncontrolled HBP or hepatic exists, evaluate drug interactions and reconsider another option if epilepsy, CVE, AVM, TBI, any cancer with suspected brain metastasis or brain neoplasia

If cytisine is indicated you may consider two schemes:

• From 1st to 3rd day one tablet every 2 hours 6 tablets. From 4th to 12th day one tablet every 2.5 hours 5 tablets. From 13th to 16th day one tablet every 3 hours 4 tablets. From 17th to 20th day one tablet every 5 hours. From 21st to 25th day one tablet every 24 hours.

• Reduced schedule: 2 tablets (3 mg) every 8 hours for 25 days

Tablets: 1.5 mg

If there is poor adherence to treatment due to adverse effects, it is possible to reduce the dose of each medication as follows:

• Varenicline 0.5 mg twice daily

• Bupropion 150 mg once daily

AVM = arteriovenous malformation.

CVE = cerebrovascular event.

HBP = high blood pressure.

NP = nicotine patches.

TBI = traumatic brain injury.

UGIB = upper gastrointestinal bleeding.

Table 3: Pharmacological recommendations for active smokers.
Nicotine replacement therapy (NRT)	NRT administration during in-hospital stay in active smokers and/or with high to moderate dependence or withdrawal symptoms regardless the degree of dependency
	Consider combination of immediate and long acting NRT if existing high dependence and/or withdrawal syndrome
	High nicotine dependence and/or consumption of < 10 cigarettes/day consider: PN 21 mg for six weeks, 14 mg for four weeks, 7 mg for two weeks
	Low to moderate dependence and/or consumption < 10 cigarettes/day consider: PN of 14 mg for six weeks and 7 mg for four weeks
	Low dependence on nicotine and consumption < 10 cigarettes/day, and/or intolerance to patch consider: Immediate-acting NRT (chewing gum, spray, inhaler or dragees) individual with dosing ad lib/for necessary reason
	Immediate-acting NRT (gum or tablet): 4 mg if they smoke their first cigarette in the first 30 minutes after waking up; 2 mg if you smoke your first cigarette after waking up. It is recommended Ad lib schema or according to the manufacturer
	NRT prescribing considerations: not recommended in uncontrolled HBP. For oral presentations not recommended if there are oral or pharyngeal lesions, history of radiation therapy to the head and neck, peptic ulcer or UGIB risk.
Oral therapy	Start treatment based on varenicline, cytisine or bupropion in hospitalized active smokers patients with a high degree of dependence, prolongue use or multiple unsuccessful abandonment attempts
	Consider varenicline, cytisine and/or bupropion, in combination with NRT
	Varenicline, its dosage will be with tablets: 0.5 mg every 24 hours day 1 to 3, 0.5 mg every 12 hours day 3 to 7 and 1 mg twice daily to complete 12 weeks
	In patients with an anxiety and/or depression profile, it is recommended to use NRT of immediate and/or prolonged action in combination with bupropion
	Bupropion dosage: 150 mg starting dose the first 3 to 7 days increasing the dose at 150 mg twice daily for 12 weeks
	Events to consider in the prescription of bupropion: contraindicate consumption of alcohol, avoid if renal failure, uncontrolled HBP or hepatic exists, evaluate drug interactions and reconsider another option if epilepsy, CVE, AVM, TBI, any cancer with suspected brain metastasis or brain neoplasia
	If cytisine is indicated you may consider two schemes: • From 1st to 3rd day one tablet every 2 hours 6 tablets. From 4th to 12th day one tablet every 2.5 hours 5 tablets. From 13th to 16th day one tablet every 3 hours 4 tablets. From 17th to 20th day one tablet every 5 hours. From 21st to 25th day one tablet every 24 hours. • Reduced schedule: 2 tablets (3 mg) every 8 hours for 25 days Tablets: 1.5 mg
	If there is poor adherence to treatment due to adverse effects, it is possible to reduce the dose of each medication as follows: • Varenicline 0.5 mg twice daily • Bupropion 150 mg once daily
AVM = arteriovenous malformation. CVE = cerebrovascular event. HBP = high blood pressure. NP = nicotine patches. TBI = traumatic brain injury. UGIB = upper gastrointestinal bleeding.