Policy

UK expands nicotine replacement therapy use in at-risk groups

Last Updated: 2006-01-03 15:36:34 -0400 (Reuters Health)

LONDON (Agence de Presse Medicale for Reuters Health) - Britain's Medicines and Healthcare Products Regulatory Agency (MHRA) has published new advice designed to allow wider use of nicotine replacement therapy in at-risk populations.

Following a review by an expert working group, it is now recommended that restrictions on the use of nicotine replacement therapy products should be minimised for pregnant and breast-feeding women, adolescents, patients with heart disease, as well as those with diabetes, kidney or liver problems.

"The working group recognised that while nicotine has pharmacological effects, in most circumstances, the well-established dangers of continued smoking far outweigh any risk from nicotine replacement therapy," the UK agency told healthcare professionals in a letter published on its Web site December 29 -- just in time for the New Year "quit smoking" resolutions.

In the case of smoking by adolescents, a widespread problem in Britain, the letter says nicotine replacement therapy may be used by 12- to 18-year olds but because there are limited safety and efficacy data, the duration of therapy should be restricted to 12 weeks and only extended on the advice of a healthcare professional.

In the case of pregnancy, it says that, ideally, pregnant women should stop smoking without using nicotine replacement therapy. If this is not possible, nicotine replacement therapy may be recommended to assist a quit attempt because the risk to the fetus of continued smoking by the mother is believed to outweigh any potential adverse effects of nicotine replacement therapy.

"The decision to use nicotine replacement therapy should be made following a risk-benefit assessment as early in pregnancy as possible. The aim should be to discontinue nicotine replacement therapy use after 2-3 months. Intermittent forms of nicotine replacement therapy are preferable during pregnancy although a patch may be appropriate if nausea and/or vomiting are a problem. If patches are used, they should be removed before going to bed at night."

The new recommendations add that nicotine replacement therapy can be used by women who are breast-feeding, because the amount of nicotine the infant is exposed to from breast milk is relatively small and less hazardous than the second-hand smoke they would otherwise be exposed to if the mother continues to smoke.

Dependent smokers with myocardial infarction, severe dysrhythmia or recent cerebrovascular accident who are in hospital should be encouraged to stop smoking with non-pharmacological interventions. However, if this fails, the use of nicotine replacement therapy could be considered under medical supervision.

In patients with stable cardiovascular disease, nicotine replacement therapy is a lesser risk than continued smoking.

In the case of diabetes mellitus, the letter notes that because nicotine releases catecholamines, which can affect carbohydrate metabolism, patients should be advised to monitor their blood sugar levels more closely than usual when starting nicotine replacement therapy.

Nicotine replacement therapy should be used with caution in patients with moderate to severe hepatic impairment or severe renal impairment, because the clearance of nicotine or its metabolites may be decreased, with the potential for increased adverse effects, it adds.