尼古丁替代物/尼古丁替代疗法

为了禁烟,老爸在家用上了电子烟,电子烟到底效果如何?是否有副作用?百度了一下,基本找不到答案,第一页被“推广”链接和“五毛、托儿”链接占领(普通不知情网民点进去,估计都会得到一个结论,电子烟,健康!神!)。不得已,转而Google英文,第2个link,写得基本清晰,正好周末比较无聊,就翻译了一把。

通过阅读这篇文章,结合找到的一些电子烟的介绍,得到的客观结论如下:

1. “电子烟”属于尼古丁替代物的一种。理论上讲,能够起到治疗烟瘾的作用。

2. 治疗者需要按照疗程以正确的方法来禁烟:全部周期8~12周;逐步减少吸烟量或者烟弹浓度。

3. 理论上讲“电子烟”只提供尼古丁,而不会包含香烟中常见的致癌物质及各种毒气。在中国,这一点能不能做到,不能下结论。中国的食品药物安全啊!!!

4. “电子烟”销售网站上基本都是虚假宣传,避重就轻。除了卖货,还是卖货,没有指导用户如何按照疗程正确使用“电子烟”的指示。

5. “电子烟”具有实际意义,为了成功实现禁烟并避免损害身体,应该选择正牌合格的烟弹。禁烟过程中,最重要的是自己的意志,需要主动自觉地控制吸烟量,逐步递减,才可能达到最终的禁烟效果。如果仅仅是把电子烟当作香烟的替代品,而不在量上逐步予以控制,是没有实际禁烟作用的。


下面的文章没有提到电子烟,但是提到了贴片、口香糖等类似于电子烟的禁烟产品,具有参考意义。电子烟和尼古丁贴片、口香糖一样,都属于尼古丁替代疗法。

原文地址:http://www.americanheart.org/presenter.jhtml?identifier=4615

尼古丁替代疗法(NRT)

美国心脏协会力荐

美国心脏协会(AHA)相信尼古丁贴片和尼古丁口香糖等尼古丁替代药物能够帮助吸烟者戒烟。贴片疗法存在一些安全问题,包括适应症、禁忌症、警告、预防等,以及潜在的滥用行为、广告和市场问题。这些被美国食品及药物管理局(FDA)所限制。美国心脏协会将继续关注替代物产品的相关科学进展,并在合适时刻向FDA作出提议。

尼古丁替代疗法(NRT)已被证明能够有效帮助吸烟者禁烟。贴片、口香糖等NRT药物都能够方便地在商店购买,它们能够单独使用,但是与综合性疗法相比疗效有所减弱。(译者注:综合性疗法指的是在专业医生的指导下,使用综合的方法进行禁烟,可能包括心理治疗、药物治疗、饮食治疗等综合的治疗行为)另外,NRT也可以以鼻腔吸入的方式来进行。

坚持使用这些禁烟产品能够让疗效更好,但是NRT本身并不能帮你停止吸烟。虽然方法变了,但是本质不变。禁烟包括多种形式,包括阅读禁烟手册,电话咨询等。总体上讲,形式改变越大,禁烟成功的可能性更大。

AHA向FDA提交过各种各样的治疗烟瘾的药物,希望这些药物不被《食品、药物和化妆品法案》所禁止。

尼古丁替代物的治疗原理

尼古丁是存在于烟草中的成瘾物质。NRT以安全的形式向患者提供尼古丁,使得患者在禁烟期无需忍受没烟抽的痛苦。禁烟需要技巧,学习这些技巧本身让禁烟更难了。

尼古丁消退症包括易怒,注意力不集中,消极感,失眠,嗜食,头疼等。这些症状只要在停止吸烟后的几个小时内就会出现。戒烟的前72个小时最难度过,并且,这些症状可能持续数周。吸烟者知道,只要一根香烟,这些症状就会完全消失。但是,NRT告诉我们,不需要香烟,只要以其它形式向患者提供尼古丁就可以消除尼古丁消退症。

NRT产品只释放尼古丁,而不会释放烟雾中包含的致癌物和各种毒气。

我应该如何使用NRT?

听从使用过NRT者、护士或者药剂师的建议

决定哪一种NRT产品最适合自己(贴片?口香糖?鼻腔吸入?)

设定一个治疗起始日期,从那天起停止吸烟,改用NRT。

坚持规律使用NRT,而不应该三天打鱼两天晒网。

使用NRT至少8到12周才能达到理想效果

NRT剂量应该逐步随着疗程减小,到最后完全停止。

一些专家建议,对于部分人群,可以复合使用多种NRT药物。例如,使用贴片满足基本尼古丁需求,配合口香糖或者鼻烟来满足突发性需求。

孕妇和心脏病人慎用NRT

孕妇:怀孕期间使用NRT有风险,但是相对于直接吸烟来说损害依然较小。对于准备怀孕的吸烟女士,可以向自己的护理医生咨询正确的戒烟方法。一般的专业建议都是先尝试其它方式,尽量避免使用尼古丁替代品,除非万不得已。所有的尼古丁替代物都有副作用,有些副作用较轻,容易随时间消退。最近的一篇文章报道,患者在进行核磁共振(MRI)治疗的时候如果使用了尼古丁贴片,可能造成烫伤。

使用NRT的时候还能吸烟吗?

NRT治疗过程中还偶尔吸烟是很常见的。大部分成功戒烟者曾有过两到三次复发(结合抽烟的情况,复发的定义是:你尝试不抽烟了,却又抽了至少一根)

使用NRT治疗的过程中依然还抽烟的问题需要分情况解决。如果患者在NRT疗程中只抽了几根烟,那么还有回归到NRT疗程轨道上来的可能。如果患者在NRT疗程中又重新抽上了,并且抽的数量跟戒烟前几乎一样多,那么他们应该考虑停止NRT疗程,重新好好想想,等准备得更充分后再重新开始戒烟(本次戒烟失败)。

NRT疗程中的剂量控制

大部分接受NRT治疗的患者能够在治疗过程中依照医嘱逐步减少NRT药物剂量。少量患者需要持续使用口香糖、贴片或鼻烟很长时间。相对地讲,使用NRT总是比直接抽烟是更有利于健康的。如果是在NRT药物与香烟之间二选一,患者总是应该选择NRT。如果患者发现逐步减少NRT药物剂量是十分难以办到的事情,那么他应该跟他的医生反映这一情况。

关于对NRT产品的任何问题可以咨询医生或者拨打制造商的电话进行咨询。

原文:

Nicotine Substitutes / Nicotine Replacement Therapy

AHA Recommendation and Advocacy Position

The American Heart Association believes that nicotine transdermal patches and other nicotine substitution drug products, such as nicotine gum, can help smokers quit when used as part of a comprehensive smoking cessation program. There are public safety issues concerning the patches — including indications, contraindications, warnings and precautions, and issues such as effectiveness, potential abuse and advertising and marketing. These are appropriately regulated by the U.S. Food and Drug Administration (FDA). The American Heart Association will continue to review the science concerning the use of nicotine patches and other nicotine substitution products and to make comments to the FDA when appropriate.

Nicotine replacement therapy (NRT) has been shown to be safe and effective in helping people stop using cigarettes when used as part of a comprehensive smoking cessation program. NRT medicines are available as gum and patches over-the-counter. They can be used by people outside formal stop-smoking programs, but they’re less effective when used that way. NRT is also available by prescription as a nasal spray and as a puffer ("inhaler").

The consistent use of one of these products doubles a person’s chances of quitting smoking. However, NRT does not "make" you stop smoking. Behavior change and support are essential. A smoking cessation program can take many forms, including self-help booklets and telephone counseling. In general, the more intense the behavior modification therapy, the greater the chance of success.

The American Heart Association commends the FDA for approving a variety of medicines to treat tobacco dependence and for determining that cigarettes and smokeless tobacco products are drugs and devices under the Food, Drug and Cosmetic Act. The association strongly supports the agency’s efforts to defend its jurisdictional determination in court. We also support Congressional efforts to give the FDA full authority to regulate all tobacco products and medicines to treat tobacco dependence in parallel, using what the agency does with one class of products to inform what it does with the other.

How do nicotine replacement products help?

Nicotine is the addictive substance in tobacco products. NRT provides nicotine in a safe form so the body doesn’t have to endure nicotine withdrawal while a person adapts to not smoking. Trying to learn skills to help in quitting smoking while dealing with nicotine withdrawal makes it harder to successfully quit.

Nicotine withdrawal symptoms include irritability, difficulty concentrating, feelings of depression, difficulty sleeping, increased appetite cravings and headache. These symptoms often start just a few hours after the last cigarette. The first 72 hours of quitting are the hardest, but symptoms may persist for weeks. Smokers have learned that a cigarette will relieve these symptoms in a few moments. But taking nicotine in another form can suppress withdrawal.

NRT products only provide nicotine. They contain none of the carcinogens or toxic gases found in cigarette smoke.

How do I use NRT?

  • Follow the advice of a general practitioner, nurse or pharmacist.
  • Decide which type of NRT best suits you.
  • Set a start date. Stop smoking and start NRT right away.
  • You should use NRT regularly at first, not “every now and then.”
  • Use NRT for at least eight to 12 weeks to have the best chance of stopping smoking.
  • The dose of NRT is typically reduced during the later stages of treatment, then stopped altogether.
  • Some experts advise using combinations of NRT medicines for some people. For example, a person might use a patch for baseline comfort supplemented by the gum or the inhaler to suppress urges as they arise.

NRT may not be suitable if you’re pregnant or have heart disease:

  • Pregnancy: while the use of replacement products during pregnancy is not risk-free, it’s much less dangerous to you and your baby than smoking. If you’re pregnant or planning to become pregnant and want to stop smoking, talk to your healthcare professional before deciding on a course of action. Most professionals will recommend trying other ways to change your behavior before suggesting a nicotine replacement product.
  • Heart disease: NRT has been shown to be safe in most people with heart disease. However, if you’ve recently had heart problems, such as an irregular or rapid heartbeat, or chest pain, consult your doctor before using nicotine replacement products.

Side effects

All forms of nicotine replacement have side effects. Many of them become easier to tolerate over time. In a recent article, the Institute for Safe Medication Practices addresses another hazard that many people may not know about — transdermal medication patches, like those that deliver nicotine, can cause burns if a patient wears them during an MRI procedure. Tell your doctor that you use a medication patch if you’re going to undergo an MRI.  

What about smoking while using NRT?

It’s not unusual for people trying to stop smoking using NRT to still give in to an occasional cigarette. Most successful quitters have two to three relapses before they quit smoking for life. (A relapse is a return to the behavior you are trying to eliminate.)

Combining the nicotine from the NRT with the nicotine from cigarettes is a concern. If someone is smoking only a few cigarettes while trying to quit, it makes sense to continue the NRT and resolve how to avoid each of the last few remaining cigarettes. But if the person is smoking as much (or nearly as much) on NRT as off of it, they should stop the NRT and prepare better before trying to quit smoking again.

What about withdrawal from NRT?

Most of the time people who use NRT to stop smoking gradually reduce or stop NRT medicine as prescribed without any difficulty. Some people keep using the gum, nasal spray or inhaler for a long time. Using NRT is always preferable to using tobacco products. If the choice is between an NRT product and a tobacco product, the person should keep using NRT. If a person feels that gradually stopping NRT is very hard, he or she should speak with a doctor.

If you have questions about NRT products, call the manufacturer’s toll-free 800 number (printed on the package label) or speak with a doctor or pharmacist.


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