Preferences among four combination nicotine treatments

Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, Los Ángeles, California, United States
Psychopharmacology (Impact Factor: 3.88). 10/2006; 187(4):476-85. DOI: 10.1007/s00213-006-0449-5
Source: PubMed


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.
To test initial reactions to and use preferences among combinations of NRTs.
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.
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).
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.

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Available from: Richard E Olmstead, May 05, 2014
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    • "Finally, in the preference testing referred to for these combinations (Schneider et al., 2006), we asked one general question about ''relief of withdrawal'' and one about ''relief of craving''—both on a 1–7 Likert scale. There were no differences among treatments in overall relief with the general items taken at the end of testing. "
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    ABSTRACT: To assess the appearance of craving and withdrawal among four combination nicotine replacement treatments (NRTs). 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). "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. 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.
    Full-text · Article · Aug 2008 · Human Psychopharmacology Clinical and Experimental
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    • "information only). As noted before (Schneider et al., 2006), companies could provide over-the-counter drug samples directly to smokers (for cost or free) for self-tailoring treatment. At the least, sampling may be useful for eliminating costly purchase of an NRT that a smoker would reject instantly. "
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    ABSTRACT: Smokers' minimal exposure to nicotine replacement treatments (NRTs) may account for poor compliance and outcome with these treatments. This study tested effects of information versus sampling of NRTs on smokers' preferences and expectations. The study was a crossover comparing information-only (INF) with sampling (SMP) methods for five NRTs: gum (2 and 4 mg), lozenges (2 and 4 mg), and inhalers. Subjects were given computer-based presentations on NRTs (INF) and rated and ranked use variables (e.g., ease, sensory/ritual, perceived relief, embarrassment) and overall choice for “use to quit.” After INF testing, subjects sampled each NRT (SMP) and again rated and ranked drugs. SMP was brief (4 min) to mimic potential use in practice. Results showed changes in perceptions and preferences post-SMP. NRT preferences shifted for overall “use to quit” (59%) and most use variables (43%–63%) post-SMP. Inhalers (generally top choice) showed a 20% drop in choice to quit (p<.04) and a 24% drop in anticipated “relief of withdrawal” (p<.04) post-SMP; 4-mg lozenge ratings increased for “relief of withdrawal” (p<.02). Ratings improved post-SMP for three of the five NRTs (“ease of use,” p<.05) but were reduced overall for liking “sensory action” (p<.003) and reduced for all but 2-mg gum for “use to quit” (p<.03). Positive changes were seen in improved ratings of NRTs chosen post-SMP. Given that reactions to NRTs change with experience, sampling should allow for a more realistic choice of NRT (self-tailoring) and better compliance versus current trial-and-error methods.
    Full-text · Article · Jan 2008 · Nicotine & Tobacco Research
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    • "Among adolescents in the United States, using the nicotine patch was considered embarrassing and the idea of nicotine gum inherently unappealing (Balch et al 2004). Embarrassment with use of the nicotine inhaler was consistently expressed among adults partaking in an American investigation, with appearance of the inhaler rated poorly and shallow puffing considered awkward (Schneider et al 2006). Gum was ranked highest for ease of use in public (Schneider et al 2005). "

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