Smokers sticking
to nicotine patch
By Karen Zagor and Clive Cookson
ederal health experts in the
US estimate bat 1.000
rrienrans die each day of
F
smoking-related diseases- According
to a former surgeon general, the
riat ion's 50m regular cigarette
smo kers are caught in the grip of an
addiction more powerful than her-
oin. Nicoune patches attached to
the upper arm are the Latest candi-
date for a miracle cure.
Unaided. fewer than 4 Per cent of
Smokers kick the habit. according
to some estimates. The advent of
hyp nor'sm' nicotine-impregnated
chewing gum. actipuoc-.~re and
behavi our modificanon therapy
have improved the odds. but most
would-be ex-smokers still fail.
,~icotin
e patches. which have
been on be market for less than
four montzhs. are selling almost as
cluck~y as thev can be made. Alza.
which makes the N,.-erm patch.
said .:s plant has been operating 24
hours-a-day, seven days-a-week
since January to meet demand. In
only two and a half manitis Nicod-
erm chalked up $60m (E35m) in
sales. "We knew that there would
be a Strong reaction." a company
spokeswoman said. "but we did not
expect such, amazing demand for
the product.
The technology behind patches is
young, but not new. A patch for
motion sickness has been available
in the US since 1981 . The product
looks Like an ordinary sucking plas-
ter. It usually has a reservoir to
hold the drug, which enters the
bloodstream by permeating the skin
at a regulated rate.
With traditional tablet medica-
tions the drug quickly passes from
the intestine to the Liver. where
enzymes often digest most of the
medication before it has had a
chance to work. As a result. tablets
often cantain high concentrations of
medi cine. Drugs administered
through a patch reach the liver at a
Slower rate. after they have already
Started to work, Consequently.
lower doses can be administered.
generally with fewer side~ffects.
While nicotine is the addictive
ingredient in cigaremLs. the biggest
risks are associated with the nitro-
sarrunes. tars and other particulates
unleashed when a cigarette is Lt.
Bv providing smokers with ruco-
une in a less toxic form the ?atches
give smokers time to change their
beh,
Iviour and give up ngarettes
without su ffering the irritability.
lack of concentration and other
symp-oms of nicotine -ith=wal.
The overncLing advantage of
Pat hes over nicotine- impregnated
chewing gum is that they are easier
to use. While gum allows parien to
regulate the ruco tine intake. in
practice many people trying to give
up tend to chew gum maniacally,
releasing too much nicotine too
clinckly and making themselves ill.
The Food & Drug Administration
has approved three nicotine patches
for prescription saies - Habitrol
marketed by Ciba Geigy, Nicoderm
by .14=on Merril Dow and ProStep
marketed by American Cyanamid's
Lederie unit. A fourth patch. to be
marketed by Warner Lambert, is
waiting for approval.
The main difference between the
competing patches Ls the mecha
nism for controlling entr7 into the
bloodstream. Some. like Nicoderm.
have a special membrane which
controls the flow of nicotine. Others
use the skin itself to contzol the
drug's flow into the bloods=am.
The doses also differ- ProStep comes
in one strength only. while Nicod-
erm. and Habitroi offer patches with
increasingly reduced doses.
The patches seem to be effective.
A study of Nicoderm's product.
presented last December in the
Journal of the American Medical
Association. showed that it had a
sLx..eek success -ate of 61 per cent
compared with 27 per cent for the
placebo.
After six months. 2.1 per cent of
the patients originally treated with
patches were still not smoking com-
pared with 11 Per cent of the pla-
cebo group. The patches work best
for heavy smokers and arie not rec-
ommended for those who smoke
less than one pack a day.
They are also mosi effective in
conjunction with behaviour-modid-
cation therapy. ProStep offers free
phone therapy from smoking~e&-
tion experts: Lederle has offered to
reimburse pharmacists for time
spent educating patients.
Stephen Rennard. one of the chief
investigators in the transdermal
rucotine study group. is enthuSias-
tic about patches as a means of mc-
otine replacement. but cautions
that -this won't cure everybody",
DynaGen. a Massachusetts ~io-
technology comDariv. is starting
clinical trials of an injectable non.
nicotine material called NicErase,
which it claims will do the same job
as the patches. [t "e~imvr-tes the
need for the harmful and addictive
ructitme.` says Indu Mur-L DynaGen
president.
U-1
CD
CC
G*,
L-4
BATCo document for Province of British Columbia 26
October 1999