Timing of nicotine lozenge administration to minimize trigger induced craving and withdrawal symptoms

Abstract

Introduction: Smokers are often advised to use nicotine lozenge when craving or withdrawal symptoms occur. This may be too late to prevent lapses. This study assessed if nicotine lozenge use prior to a common smoking trigger can minimize trigger induced increases in craving and withdrawal symptoms.

Methods: Eighty-four smokers completed two laboratory sessions in random order. At one session, nicotine lozenge was given immediately after a stressor (to approximate current recommended use - i.e., after craving and withdrawal symptoms occur); at the other session subjects were randomized to receive nicotine lozenge at time points ranging from immediately to 30min prior to the stressor. Withdrawal symptoms and urge to smoke were measured using the Minnesota Nicotine Withdrawal Scale and the Questionnaire of Smoking Urges (QSU).

Results: Relative to receiving lozenge after the stressor, a smaller increase in pre-stressor to post-stressor withdrawal symptom scores occurred when lozenge was used immediately (p=0.03) and 10min prior (p=0.044) to the stressor. Results were similar for factors 1 and 2 of the QSU when lozenge was used immediately prior to the stressor (p<0.03) and for factor 1 of the QSU when lozenge was used 10min prior to the stressor (p=0.028). Absolute levels of post-stressor withdrawal symptom and urge to smoke severity were lower when lozenge was given prior to versus after a stressor.

Conclusions: Administering the nicotine lozenge prior to a smoking trigger can decrease trigger induced craving and withdrawal symptoms. Future studies are needed to determine if such use would increase cessation rates. Clinicaltrials.gov # NCT01522963.

Keywords: Craving; Nicotine Lozenge; Smoking; Withdrawal symptoms.

Conflict of interest statement

Conflict of Interest:

Dr. Kotlyar has received grant funding through the Global Research Award for Nicotine Dependence (GRAND) program funded by Pfizer.

Copyright © 2017 Elsevier Ltd. All rights reserved.

Figures

Figure 1

Outline of each laboratory assessment with subjects assigned to condition A at one laboratory session and one of the other conditions at the other laboratory session. The order of laboratory assessments (i.e., condition A vs. other condition) was assigned randomly.

Figure 2

Flow of subjects through the study

Figure 3

Withdrawal symptom severity when subjects received nicotine lozenge after stress exposure (i.e., control) and when subjects received nicotine lozenge immediately before (panel 1), 10 minutes (panel 2), 20 minutes (panel 3), and 30 minutes (panel 4) before speech. The speech task occurred between time −0 and +0 with assessments prior to the stressor indicated as (−) time and those after as (+) time. p value for (z – y vs. x – w) indicates significance of difference in stress response magnitude between experimental and control condition. p value for z vs. x indicates significance of difference in post stress withdrawal symptoms severity (where the value at time −30 was subtracted from the value at time +0 to adjust for baseline) between the experimental and control condition.