Help Patients Break the E-Cigarette Habit

Patients will ask for help with "vaping cessation"...as reports of e-cigarette harms and deaths continue to rise.

But there's no good evidence on how to break the vaping habit.

Get your pharmacist involved to recommend possible approaches...based on patient preference, vaping history, and other factors.

Expect most patients to use nondrug strategies to stop smoking cigarettes. For example, patients can set a quit date...avoid triggers...and get free support at GoSmokeFree.gc.ca/quit or BreakItOff.ca.

These may be enough for some patients, such as "social" users.

Adding nicotine replacement therapy (NRT) may be worth a try for some patients who regularly use e-cigs...since most e-cigs have nicotine.

Help ensure e-cigarette users who try NRT get an appropriate product. Most of these patients will use a nicotine patch...PLUS a short-acting product (gum, etc) for breakthrough cravings.

Ask patients which e-cig product they use...and how much they vape. Then check the e-cig's package or website for nicotine content. These details can help your pharmacist suggest a nicotine patch dose.

For example, Juul 5% contains about 40 mg nicotine per "pod," similar to smoking a PACK of cigarettes. For an adult vaping more than half a pod/day, a 21 mg/day patch may be a reasonable starting point.

But a 14 mg/day patch may be better for patients using less nicotine. For instance, Vype 1.6% contains about 15 mg nicotine per half pod.

Be prepared to dispense Rx meds if NRT isn't enough. Some patients may try varenicline (Champix) or bupropion SR.

Use our new Vaping Cessation Guide to find nicotine content in common e-cigarettes...plus other strategies to help patients quit.

Key References

  • www.canada.ca/en/public-health/services/diseases/vaping-pulmonary-illness.html (11-19-19)
  • MMWR Morb Mortal Wkly Rep 2019;68(41):919-27
  • Expert Opin Drug Deliv 2019;16(11):1193-203
  • BMJ Open 2019;9(3):e026642
  • J Am Coll Cardiol 2018;72(25):3332-65
Pharmacy Technician's Letter Canada. December 2019, No. 351202



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