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Sccgov.org

Non-Nicotine
Nicotine Replacement Therapy (NRT) Products
Varenicline
Bupropion SR
Oral Inhaler
Nasal Spray
3) Provide patient with the prescriptions(s). 2) W MD/P In order for patient to receive medications(s) to quit smoking, he/she must obtain a certification of completion from a smoki 0.5 mg,1 mg tablet Rx Chantix
tablet 150 sustained-release Rx Zyban
vapor 4mg inhaled nicotine 10 mg cartridge delivers Rx Nicotrol Inhaler
solution aqueous nicotine nicotine in 50 mcg Metered spray 0.5 mg Rx Nicotrol NS
24 hour release 7mg, 14mg, 21mg OTC/Rx Generic
7mg, 14mg, 21mg OTC Nicoderm CQ
Flavor: mint 2mg, 4mg OTC Commit, Generic
mint, orange freshmint, fruit chill, Flavors: original, 2mg, 4mg OTC Nicorette, Generic
A/NP: please perform the following: 1) Fill out the referral from and fax it to rxonline.epocrates.com Academy of Family Physicians Intended Use:
start ˉ after waking up, or 1 ≥20 cig q day and/ This chart serves as a basic, summarized information about smoking cessation medication and insurance coverage. Please refer to • •
• • • •
course may be used in selected patients Duration: HD: day Renal Failure: W Days 4-7: Days 1-3:
• •
• • •
Duration: Max: dose frequency and/or amount. Mild-mod Cirrhosis: consider lower the dose. Renal Failure: Day 4 & on: Days 1-3:
Duration: mins. Best result if continuous puffing for 20 Begin with at least 6 cartridges q day Individualized dosing 6-16 cartridges q day
• • • • • •
Duration: Max: Begin with at least 8 doses q day Each spray has 0.5mg of nicotine 1 dose = 2 sprays (One in each nostril) 1-2 doses/hr (8-40 doses q day)
Duration: or lozenge ≤5 7mg x 4-6 wks 6-10 14mg x 4-6 wks; 7mg x 2 wks 1 14mg x 2-4 wks; 7mg x 2 wks ≥15cig/day:
• • • • •
• • • • •
Duration: Max: W W W
Duration: Max: W W W
rite prescription(s) base on the insurance coverage and smoking history eeks 2-12:
eek 10-12: eek 7-9: eek 1-6:
eek 10-12: eek 7-9: eek 1-6:
cig/day:
cig/day:
cig/day:
Health Education Department
full glass of water T Start 1 week prior to quit date date T and one in early evening Then take one in the morning 3 days T for 24 hours Open cartridge retains potency (like cigarette) Do not inhale into the lungs puf Inhale into back of throat or Puf blowing the nose nose. W to keep the nasal spray in the If the nose runs, gently snif while spray Do not snif every hour Spray one spray in each nostril Clear the nasal passages first back on if it falls of Use medical tape to tape it place each day Put the patch on at dif the mouth until it is gone Switch it from place to place in Suck on each lozenge slowly Repeat on & of Chew again until the tingling fades Park between cheek and gum you feel tingling Chew each piece slowly until at
408.793.2781
Symptoms and Suicidality *Black Box W
Cardiovascular disease adjustment is necessary) Severe renal impairment (dosage Pregnancy Symptoms and Suicidality *Black Box W
therapy in previous 14 days alcohol or sedative use, MAO inhibitor bulimia or anorexia nervosa, heavy Contraindications:
Severe hepatic cirrhosis seizure threshold or medical conditions know to lower the Concomitant therapy with medications Pregnancy Bronchospastic disease Serious or worsening angina pectoris Serious underlying arrhythmias Recent MI (≤ 2 wks) Pregnancy Bronchospastic disease (rhinitis, nasal polyps, sinusitis) Underlying chronic nasal disorders Serious or worsening angina pectoris Serious underlying arrhythmias Recent MI (≤ 2 wks) Pregnancy Serious or worsening angina pectoris Serious underlying arrhythmias Recent MI (≤ 2 wks) Pregnancy Serious or worsening angina pectoris Serious underlying arrhythmias Recent MI (≤ 2 wks) Pregnancy TMJ Serious or worsening angina pectoris Serious underlying arrhythmias Recent MI (≤ 2 wks) Pregnancy ng cessation program and prescriptions to any V VHPHealthEducation@hhs.sccgov
.drugs.com/cons/nicotrol-inhalation-oral-nebulization.html other agents who have failed action for patients mechanism of Of Easy to use depression patients with beneficial in Might be N Can be used with Easy to use smoking mouth ritual of Mimics hand-to- Eases cravings Put on once a day 24 hrs nicotine level over consistent Provides conceal Easy to use and control on dosing Have more cravings Eases oral control on dosing Have more gain Delays weight cravings Eases oral the medication insert sleeve or consult with pharmacy for more information about the medication or changes in medication cover yet available surveillance data not Post-marketing about 1/3 of patients Nausea occurs in preclude use and precautions contradictions Several increased Seizure risk is conditions used in very cold warm conditions or not be stored in very Cartridges should irritation Initial throat/mouth machinery operating heavy before driving or Must wait 5 minutes result Dependence can Nasal/throat irritation dermatitis Not for patient with adhesive may occur Allergic reactions to Fixed dose May upset stomach or being overdosed to avoid side ef Must suck correctly or being overdosed to avoid side ef Must chew correctly Difficult for dentures acceptable May not be socially V Flatulence Constipation dream Insomnia, abnormal Nausea Seizures (1/1,000) Constipation Rash concentrating difficulty Nervousness/ Dry mouth Insomnia Headache Hiccups Dyspepsia Rhinitis Cough Unpleasant taste Mouth/throat irritation Headache Cough Sneezing T Rhinitis Nasal/throat irritation absorption) nocturnal nicotine (associated with vivid dreams Insomnia, abnormal/ Headache burning) (erythema, pruritus, Local skin reactions Insomnia Flatulence Headache Heartburn Cough Hiccups Nausea Hypersalivation Dyspepsia Hiccups Mouth/jaw soreness T Nausea/vomiting Angina Seizures consciousness Loss of Hallucinations Slow heartbeat Seizures Confusion Drooling Cold sweat Confusion Dizziness Diarrhea Drooling Nausea/vomiting Cold sweat W Nausea/vomiting Fast heartbeat Diarrhea Dizziness .ncbi.nlm.nih.gov/pubmedhealth/PMH0000347/ before prescribing the medication(s). *Insurance coverage for NR MediCal:
No Insurance: V V SCFHP: SR, Buproban or Bupropion HCl Medicare Part D Drug Coverage: Medicare: Medical with Share of Cost MediCal: Bupropion HCl Blue Cross:
alley Health Plan: alley
No Insurance: V V SCFHP: Medicare Part D Drug Coverage Medicare: Medical with Share of Cost: MediCal: Blue Cross:
alley Health Plan: alley
Valley Health Plan
Valley Health Plan Insur
Care/APD/MediCal
Care/APD/MediCal
12 weeks per 6 months (56 tablets per fill) 12 weeks per 6 months (60 tablets per fill) 12 weeks per 6 months (28 patches per fill) Not covered. Check for low or no cost medicines by calling is required unless it is prescribed under Budeprion SR, Buproban or Not covered. Check for low or no cost medicines by calling Partnership Medical
Partnership Medical
Assistant
Pending:
Assistant
Pending:
Prescription
Depends on plan. May substitute with Budeprion Prescription
Program
Program
Assistance
Assistance

Source: http://www.sccgov.org/sites/sccphd/en-us/HealthProviders/TobaccoPrevention/Documents/Approved%20NRT%20Table%20-%2002222012.pdf

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