April 22, 2014
Attention All Clinicians:
The new smoking cessation order set was approved for use at all five hospitals and is live in Soarian orders
now. The system CEC Sub-Committee on COPD encourages its use. The order set is in the computer named
MH Smoking Cassation. The base order set provides recommended dosing. Additional information is provided in
the order set on contraindications, drug-drug interactions, and monitoring.
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Smoking Cessation Standing Orders
The patient has been advised to stop smoking and not to restart
The patient has indicated a readiness to quit and received quit smoking handouts
Patient has none of the following precautions for use of nicotine replacement:
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Pregnancy or breastfeeding
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Is within 2 weeks post myocardial Infarction
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Serious underlying arrhythmias
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Serious or worsening angina pectoris
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Dermatologic conditions
The Nicotine products listed below can be used as monotherapy or as combination therapy. Combination therapy should
include a nicotine patch plus gum.
Nicotine replacement therapy: Recommended Dosing and available products
Cigarettes per Day
Equivalent Pack per
Recommended Starting Dosing
Day
Transdermal Patches
10 or less
½ pack or less
14 mg per day
( 7 mg, 14 mg, 21 mg)
11 or more
½ pack or more
21 mg per day
Nicotine Gum
( 2 mg , 4 mg)
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24 cigarettes or
less
25 cigarettes or
more
1 pack or less
2 mg (Max 24 pieces per day)
1 pack or more
4 mg ( Max 24 pieces per day)
NicotineTransdermal Replacement Therapy (Choose only one) :
Nicotine Transdermal Patch 21 mg Apply daily at 0900.
Nicotine Transdermal Patch 14 mg Apply daily at 0900.
Nicotine Transdermal Patch 7 mg Apply daily at 0900.
Remove prior days patch. Rotate site daily. Apply new patch to non-hairy, clean, dry skin on upper body or
upper arm. If patient complains of vivid dreams or insomnia:obtain a new order to remove patch at 2100.
Call physician if local skin reactions occur such as: erythema, pruritis or burning.
Nicotine Gum Replacement Therapy (Choose only one):
Nicotine Gum 2 mg q1 hour prn breakthrough symptoms
Nicotine Gum 4 mg q 1 hours prn breakthrough symptoms
Gum should be chewed until it tingles then parked for between gum and cheek. When tingling is gone, chew
again until tingle returns and re-park. Repeat until tingling is gone. Discard. Use caution with dentures.
Patient has been advised to seek follow up care following discharge
For new starts select one of the following:
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Bupropion SR 150 mg PO daily for 3 days than 150 mg PO twice a day
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Varenicline (Chantix) 0.5 mg PO daily for 3 days than 0.5 mg PO twice a day for 4 days, than 1 mg PO twice
a day
If CrCL < 30 mL/min- Varenicline (Chantix) 0.5 mg PO twice a day
If on hemodialysis – Varenicline (Chantix) 0.5 mg PO daily
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