title: Varying nicotine patch dose and type of smoking cessation counseling.
abstract: OBJECTIVE
  To compare the efficacy and safety of 22-mg and 44-mg doses of transdermal nicotine therapy when it is paired with minimal, individual, or group counseling to improve smoking cessation rates.
  
  
  METHODS
  An 8-week clinical trial (4 weeks double-blind followed by 4 weeks open label) using random assignment of participants to both dose (22 or 44 mg) and counseling (minimal, individual, or group) conditions.
  
  
  METHODS
  Daily cigarette smokers (> or = 15 cigarettes per day for at least 1 year) who volunteered to participate in a study of smoking cessation treatment. A total of 504 participants were enrolled at two sites.
  
  
  METHODS
  Four weeks of 22- or 44-mg transdermal nicotine therapy followed by 4 weeks of dosage reduction (2 weeks of 22 mg followed by 2 weeks of 11 mg). Counseling consisted of a self-help pamphlet (minimal); a self-help pamphlet, a brief physician motivational message, and three brief (< 15 minutes) follow-up visits with a nurse (individual); or the pamphlet, the motivational message, and eight weekly 1-hour group smoking cessation counseling visits (group). All participants returned weekly to turn in questionnaires and for assessment of their smoking status.
  
  
  METHODS
  Abstinence from smoking was based on self-report, confirmed by an expired carbon monoxide concentration lower than 10 ppm. Withdrawal severity was assessed by means of an eight-item self-report questionnaire completed daily.
  
  
  RESULTS
  Smoking cessation rates for the two nicotine patch doses and three levels of counseling did not differ significantly at either 8 weeks or 26 weeks following the quit date. Among those receiving minimal contact, the 44-mg dose produced greater abstinence at 4 weeks than did the 22-mg dose (68% vs 45%; P < .01). Participants receiving minimal-contact adjuvant treatment were less likely to be abstinent at the end of 4 weeks than those receiving individual or group counseling (56% vs 67%; P < .05). The 44-mg dose decreased desire to smoke more than the 22-mg dose, but this effect was not related to success in quitting smoking. Transdermal nicotine therapy at doses of 44 mg produced a significantly greater frequency of nausea (28%), vomiting (10%), and erythema with edema at the patch site (30%) than did a 22-mg dose (10%, 2%, and 13%, respectively; P < .01 for each adverse effect). Three serious adverse events occurred during use of the 44-mg patch dose.
  
  
  CONCLUSIONS
  There does not appear to be any general, sustained benefit of initiating transdermal nicotine therapy with a 44-mg patch dose or of providing intense adjuvant smoking cessation treatment. The two doses and all adjuvant treatments produced equivalent effects at the 26-week follow-up, and the higher patch dose produced more adverse effects. Higher-dose (44-mg) nicotine replacement does not appear to be indicated for general clinical populations, although it may provide short-term benefit to some smokers attempting to quit with minimal adjuvant treatment.
authors.affiliation: Center for Tobacco Research and Intervention, University of Wisconsin-Madison, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Jorenby
authors.forename: S S
authors.initials: SS
authors.lastname: Smith
authors.forename: M C
authors.initials: MC
authors.lastname: Fiore
authors.forename: R D
authors.initials: RD
authors.lastname: Hurt
authors.forename: K P
authors.initials: KP
authors.lastname: Offord
authors.forename: I T
authors.initials: IT
authors.lastname: Croghan
authors.forename: J T
authors.initials: JT
authors.lastname: Hays
authors.forename: S F
authors.initials: SF
authors.lastname: Lewis
authors.forename: T B
authors.initials: TB
authors.lastname: Baker
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000704:Analysis of Variance; D002248:Carbon Monoxide / Q000378:metabolism; D003131:Combined Modality Therapy; D003367:Cotinine / Q000097:blood; D003376:Counseling; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage* / Q000627:therapeutic use; D016540:Smoking Cessation / Q000379:methods*; D013375:Substance Withdrawal Syndrome
chemical_list: D009538:Nicotine; D002248:Carbon Monoxide; D003367:Cotinine