Friday, May 18, 2007

Nicotine Replacement Therapy

~cigarette reaches brain 7-10 seconds
~patch :levels peak 2-6 hours
~gum: 20-30 minutes
~inhaler: 10-20 minutes

Therefore…still need to learn to tolerate cravings.

Who should use NRT?
Assess case by case
~Behavioural analysis
10 cigarettes or less not a good NRT candidate

Why NRT?
~Provides the body with sufficient nicotine to minimize withdrawl cravings
~Eliminates toxic substances from cigs
~Doubles quit rates -+103 studies proves
~Most effective with behavioural therapy
~Can be a part of cutting down

Naturopathic “NRT”
~Products to increase dopamine (tyrosine/DOPA/dopamine) (B6)[i]
-released by hypothalamus; precursor to epi + norepi synthesis in adrenals and nervous tissue
- activated with unexpected rewards in brain i.e. learned behaviours.
~ St. Johns Wort (see study Canadian Herbalism Journal)[ii]
~Sulphonyl (MSM)[iii]

Nicotine Gum:
~2mg or 4mg doses
~ “rescue” medication; doesn’t help chronically
~chew a few times then “park” on gums for oral mucosal absorption
~Females require higher doses of NRT (studies say). Therefore use 4mg.
~1 piece/hour. Max. up to 15 pieces.
~Provides nicotine w/in 20-30 minutes
~Nicotine receptors along GI : possible s/e = hiccups, st. upset
~Caffeine/acidity products lower absorption

The Inhaler
~S/E: nausea, st.upset, HA, mouth/throat irritation
~each cartridge = 10mg nicotine/1mg menthol
~can titrate use to pm/cartridge/24hours
-i.e. take 1-2 puffs, see if craving gone

The Patch:
~24 h continuous dose ideal for +1 pack/day
~can cut or alter patch (i.e. ½, ¾)
~may cause nightmares
~may cause local skin irritation: nicotine is an irritant
~21mg = +15 cigs/day
~14 mg = +7 cigs/day
~rotate patch site
~can combine with gum or inhaler

[i] Effect of vitamin B-6 nutrition on the levels of dopamine, dopamine metabolites, dopa decarboxylase activity, tyrosine, and GABA in the developing rat corpus striatum.


At 8:06 PM, November 10, 2008, Anonymous Mariel said...

Great work.


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