ABSTRACT
OBJECTIVE: To assess the appearance of craving and withdrawal among four combination nicotine replacement treatments (NRTs). METHODS: In a crossover trial of NRT preferences, 27 smokers tested 4 combinations of nicotine treatments: 2 mg/4 mg gums + 15 mg patch, 2 mg/4 mg lozenges + 15 mg patch, inhalers + 15 mg patch, and 10 + 15 mg double patch (approximately 25 mg). Overnight abstinence was required prior to (1/2) day testing of each combination. Combination NRTs were used for approximately 6 h/day. Subjects resumed smoking each afternoon. For this report, we used the Smoker Anchored Withdrawal Grid to look at craving and withdrawal scores over 5 days of testing (smoking baseline + four treatment days). RESULTS: "Urge to smoke" and "total withdrawal" showed a rise from baseline to NRT use for the double patch but not for the three acute + patch conditions. Lozenge/patch scores did not rise from baseline for "craving" and "miss a cigarette" but did for gum/patch, inhaler/patch, and double patch. The best relief occurred for NRTs of choice. CONCLUSION: This was a small but suggestive finding regarding the potential of patch plus adjunct ad lib NRT. With little data on relief with NRT combinations, more systematic tests are needed.
Subject(s)
Nicotine/administration & dosage , Smoking Cessation/methods , Smoking Prevention , Substance Withdrawal Syndrome/drug therapy , Adult , Cross-Over Studies , Female , Humans , Male , Smoking Cessation/psychologyABSTRACT
RATIONALE: Acute nicotine replacement treatments (NRTs) are disliked or misused, leading to insufficient nicotine intake and poor outcome. Patches provide steady nicotine but are slow and passive. Combining systems may improve efficacy with acute NRTs tailored for compliance. OBJECTIVE: To test initial reactions to and use preferences among combinations of NRTs. MATERIALS AND METHODS: Smokers (n=27) tested four combination NRTs in a 5-day crossover trial: 2/4-mg gum + 15-mg patch (G/P), 2/4-mg lozenges + 15-mg patch (L/P), inhaler + 15-mg patch (I/P), and 10 mg + 15-mg patches (P/P). Subjects rated an NRT combination each day after 5-6 h of use and ranked among the NRTs after testing all treatments. RESULTS: Double-patches (P/P) were ranked highest for "ease of use", "safety", and "use in public". However, for "help to quit", 70% preferred some form of acute-patch combination (A/P) compared to 30% choosing P/P. For "use under stress" (an immediate need), 93% preferred A/P systems compared to 7% choosing P/P. L/P ranked lowest for "ease of use", I/P and L/P were lowest on "safety", and I/P ranked lowest for "use in public". Expectations of NRTs changed with test experience for patches (better) and lozenges (worse). CONCLUSIONS: In brief testing, all combinations were acceptable. P/P was favored for ease, safety, and public use, but a majority chose A/P systems for help in quitting and use under stress. Combined use is viable and needs to be made known and accessible to smokers.
Subject(s)
Nicotine/therapeutic use , Nicotinic Agonists/therapeutic use , Patient Satisfaction , Smoking Cessation/methods , Tobacco Use Disorder/drug therapy , Administration, Cutaneous , Administration, Inhalation , Administration, Oral , Adult , Chewing Gum , Cross-Over Studies , Female , Humans , Male , Middle Aged , Nebulizers and Vaporizers , Nicotine/administration & dosage , Nicotinic Agonists/administration & dosage , Research Design , Self Administration , Tablets , Time Factors , Treatment OutcomeABSTRACT
RATIONALE: Misuse or dislike of nicotine replacement treatments (NRTs) undermines their effectiveness. Brief testing among NRTs could allow tailoring by preference to improve outcome. OBJECTIVE: To test initial reactions/preferences to NRTs in a single session crossover design with guided use. METHODS: Smokers were offered two doses of three NRTs: gum (2 and 4 mg), inhaler, and nasal spray (NNS) in a 5-h test with proper use enforced. Subjects rated each NRT and ranked among NRTs on use variables and preferences. RESULTS: Gum was ranked over inhaler and NNS for "ease of use," "safety" and "prefer in public." Four-milligram gum was rated higher than 2 mg on several variables. With experience, "ease of use" and "liking" improved for gum. Both inhaler and NNS ranked low on considering "use >3 months" vs gum. Dislike of NRT was reflected in refusal of second doses. For those testing all doses (n=9), inhaler ranked last on "relief of withdrawal," "choose under stress," and "choice to help quit." Craving and withdrawal were relieved over time with any NRT use. CONCLUSIONS: Sampling of treatments can identify reactions key to initial compliance with these NRTs.