nicotineAdjunctive therapyBrands: Nicoderm CQ, Nicorette | Smoking cessation support via nicotine replacement therapy (review/guideline). View labelExact | Patch dosing is commonly step-down based on baseline cigarette use. For Nicoderm CQ, one labeled schedule is: >10 cigarettes/day: Step 1 (21 mg) weeks 1–6, Step 2 (14 mg) weeks 7–8, Step 3 (7 mg) weeks 9–10 (label). | Nicotinic acetylcholine receptor agonist used in nicotine replacement therapy (NRT) to reduce withdrawal symptoms and cravings during smoking cessation; best outcomes occur when paired with behavioral support and follow-up (review/guideline). | CYP2A6 (primary; nicotine → cotinine) (review) | Single-dose mean 2 h | No | — | - Track smoking status and withdrawal symptoms; ensure counseling support and troubleshoot adherence (clinical).
- Monitor sleep disturbance and adjust patch wear time (16h vs 24h) when insomnia or vivid dreams are problematic (label/clinical).
- If the patient takes CYP1A2 substrates (e.g., clozapine or olanzapine), plan follow-up for potential level increases after quitting smoking (clinical).
| No | 2025-12-31 |
|---|
| Smoking cessation (label). View labelExact | Label dosing is typically started before the target quit date with a short titration to reduce nausea, then continued for a defined course (often 12 weeks) with behavioral support (label/guideline). | Nicotinic acetylcholine receptor partial agonist (α4β2) used to support smoking cessation by reducing cravings and blunting nicotine reinforcement; often paired with behavioral support (label/guideline). | Minimal metabolism; primarily renal excretion (label) | Single-dose mean 24 h | No | — | - Track smoking status and document quit attempts, because medication doses for CYP1A2 substrates may need reassessment when smoking stops (clinical).
- Monitor nausea and sleep effects early; adjust the plan based on tolerability and functional impact (label/clinical).
- Monitor mood symptoms during cessation attempts, especially in people with active depression/anxiety or unstable psychiatric illness (clinical).
- Renal function assessment is commonly used when comorbidity is present or when severe impairment is suspected (label/clinical).
| No | 2025-12-30 |
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bupropionAdjunctive therapyBrands: WELLBUTRIN | MDD; seasonal affective disorder; smoking cessation (SR). View labelExact | XL: start 150 mg qAM for 3–7 days, increase to 300 mg qAM; may increase to 450 mg qAM if needed. | Norepinephrine–dopamine reuptake inhibitor (NDRI). | CYP2B6 | Steady-state mean 21 h | No | — | - Blood pressure at baseline and after dose changes, especially when nicotine replacement is used.
- Seizure risk factors (eating disorder history, alcohol/benzodiazepine withdrawal, electrolyte disturbances) before initiation and at follow-up.
- Sleep and anxiety during early titration; dose timing and titration speed are common levers for tolerability.
- Mood elevation or agitation in bipolar-spectrum illness; coordinate prevention plans via the bipolar disorder hub.
- Medication list review to ensure only one bupropion-containing product is active (to reduce accidental dose escalation across brands).
| No | 2026-02-12 |
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| Depression; use with caution in adolescents and patients with cardiac disease. View labelExact | Typical start is 25 mg HS with titration every 3–7 days as tolerated to 75–100 mg/day (single HS or divided). | Tricyclic antidepressant (TCA); predominantly norepinephrine reuptake inhibition. | CYP2D6 | Single-dose mean 36 h; Single-dose range 18–90 h | 50–150 ng/mL | | - Baseline ECG for patients >40 years, cardiac disease, electrolyte abnormalities, or higher target doses; repeat after major dose changes or when adding QT-active medications.
- TDM after steady state (about 7–10 days) and after dose adjustments; track both symptom response and adverse effects when interpreting levels.
- Orthostatic vitals, falls risk, and anticholinergic burden (bowel and bladder symptoms), especially in older adults or when adding anticholinergic co-medications.
- Mood activation and suicidality during initiation and titration, particularly in adolescents/young adults and in bipolar-spectrum illness.
- Medication reconciliation for CYP2D6 inhibitors/inducers, QT-active agents, and serotonergic combinations; include OTC antihistamines and decongestants.
| No | 2025-12-29 |
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