Health and Lifestyle Research Unit, Queen Mary University of London, London, UK.
Fundación Enfisema, Instituto Ave Pulmo, Mar del Plata, Argentina.
Addiction. 2019 Mar;114(3):515-522. doi: 10.1111/add.14483. Epub 2018 Dec 11.
Nicotine replacement therapy (NRT) may be more effective in aiding smoking cessation if higher doses of nicotine from it can be tolerated. We examined the responses to, and 4-week abstinence rates observed, when titrating the dose of transdermal nicotine patch up to 84 mg/day over 4 weeks prior to a target quit date and titrating down again over 4 weeks afterwards.
Clinical cohort study.
Tobacco dependence clinic, Mar del Plata, Argentina.
Fifty smokers seeking help with stopping smoking.
Participants started on one 21-mg/24-hour patch 4 weeks prior to their target quit day (TQD). The dose was increased weekly by adding a 21-mg patch unless participants reported adverse effects and/or did not wish to increase the dose. The dose was reduced by 21 mg/day each week from 1 week post-TQD, until it reverted to the standard dose (21 mg/day) at 4 weeks post-TQD. Participants received weekly behavioural support and could also use oral NRT from the TQD. Participants were advised to smoke ad libitum during the pre-quit period.
Proportion of participants progressing through each stage of dosing, adherence, adverse effects, changes in cigarette consumption, smoke intake and enjoyment of smoking during the pre-quit period; withdrawal symptoms; carbon monoxide-validated abstinence during 4 weeks post-TQD.
Of the 50 participants, 72.0% (n = 36) progressed to the 84-mg nicotine dose and 94.0% (n = 47) completed the trial. Adverse effects consisted primarily of nausea and were mild and well tolerated. Cigarette consumption, smoke intake and enjoyment of smoking declined significantly during the pre-quit period. Forty-one (82%) participants achieved 4 weeks validated abstinence. Abstainers experienced no detectable cigarette withdrawal symptoms.
Most smokers seeking help with stopping appear to be able to tolerate doses of transdermal nicotine patch up to 84 mg/day during a 4-week pre-quit up-titration period with minimal side effects.
如果能耐受尼古丁替代疗法（NRT）中更高剂量的尼古丁，那么该疗法可能更有助于戒烟。我们研究了在目标戒烟日之前 4 周内逐渐增加透皮尼古丁贴片剂量至 84mg/天，之后再在 4 周内逐渐减少剂量，观察在此过程中对药物的反应和 4 周的戒烟率。
临床队列研究。
阿根廷马德普拉塔的一个烟草依赖诊所。
50 名寻求戒烟帮助的吸烟者。
参与者在目标戒烟日（TQD）前 4 周开始使用一片 21mg/24 小时的贴片。每周增加一片 21mg 的贴片，除非参与者报告有不良反应和/或不想增加剂量。从 TQD 后第 1 周开始，每周减少 21mg 剂量，直到 TQD 后 4 周恢复到标准剂量（21mg/天）。参与者每周接受行为支持，也可以从 TQD 开始使用口服 NRT。在戒烟前期间，建议参与者随意吸烟。
参与者在每个剂量阶段的进展比例、依从性、不良反应、戒烟前期间香烟消耗、吸烟量和吸烟享受的变化、戒断症状、TQD 后 4 周内经一氧化碳验证的戒烟率。
在 50 名参与者中，72.0%（n=36）进展到 84mg 尼古丁剂量，94.0%（n=47）完成了试验。不良反应主要为恶心，症状轻微且可耐受。在戒烟前期间，香烟消耗、吸烟量和吸烟享受显著下降。41 名（82%）参与者实现了 4 周的经一氧化碳验证的戒烟。戒烟者没有出现可检测到的香烟戒断症状。
大多数寻求戒烟帮助的吸烟者似乎能够耐受 4 周的戒烟前递增剂量至 84mg/天的透皮尼古丁贴片，副作用极小。
