News: New NRT lozenge

The Pharmaceutical Journal Vol 267 No 7169 p495-500
13 October 2001

New NRT lozenge

A new oral form of nicotine replacement therapy, NiQuitin CQ lozenge, has been launched by GlaxoSmithKline. The company says that the pharmacy medicine can triple the chances of stopping smoking compared with placebo.

Results from a randomised, placebo-controlled trial, which involved 1,818 smokers, were presented by Dr Robin Cregeen, a consultant in pharmaceutical medicine to GlaxoSmithKline, at the product’s launch on 4 October. He said that at all time points in the trial the active drug was found to be superior to placebo.

In addition, heavily dependent smokers who were using more than the average number of lozenges per day were five times more likely to stop smoking than those given placebo. After six weeks, 56.8 per cent of these subjects using 4mg lozenges were abstinent compared with 19.2 per cent of subjects using placebo lozenges.

In contrast to other NRT products, the dose of lozenge, either 2mg or 4mg, is determined by the time between waking and first cigarette not by the number of cigarettes smoked per day. Those who smoke soon after waking (within 30 minutes) are considered to have a strong dependency and the company recommends that the 4mg lozenge should be used. Those who do not smoke their first cigarette within 30 minutes of waking are considered less dependent and should use the 2mg lozenge. The step-down dose schedule for the lozenge does not involve transferring to a lower strength product but involves a reduction in the number of lozenges used.

GlaxoSmithKline recommends that during weeks one to six of the treatment programme, one lozenge is taken every one to two hours and that a minimum of nine lozenges per day are used. This is reduced to one lozenge every two to four hours for weeks seven to nine and to one lozenge every four to eight hours during weeks 10 to 12. Users should not exceed 15 lozenges per day.

“The allocation of lighter, but dependent smokers, to the 4mg lozenge was found to be unproblematic,” Dr Cregeen said.

Also speaking at the launch, community pharmacist Dr Terry Maguire, said that pharmacists had a role to play in providing smoking cessation services. However, pharmacists were sometimes too cautious in recommending NRT. Dr Maguire cited pregnant women and patients with angina as examples of people who should not be denied NRT if they wanted help to stop smoking. “Empowering patients is not something that comes easily to pharmacists,” he said.