How to treat a patient who vapes?

From the Guidelines

Treating a patient who vapes requires a comprehensive approach focusing on both the physical and psychological aspects of vaping dependence, with the most effective treatment being a combination of pharmacotherapy and behavioral counseling, as evidenced by the most recent study 1. When treating a patient who vapes, it is essential to assess their vaping history, including frequency, nicotine concentration, and reasons for use.

• For those wanting to quit, recommend nicotine replacement therapy (NRT) options such as nicotine patches (21mg/24hr for heavy users, tapering down over 8-12 weeks), nicotine gum (2-4mg as needed, up to 24 pieces daily), or lozenges (2-4mg, up to 20 daily).
• Prescription medications like varenicline (Chantix, 0.5mg daily for 3 days, then 0.5mg twice daily for 4 days, followed by 1mg twice daily for 12 weeks) or bupropion (Zyban, 150mg daily for 3 days, then 150mg twice daily for 7-12 weeks) may be appropriate for some patients.
• Combine pharmacotherapy with behavioral counseling, as this combination significantly improves quit rates, with studies showing that varenicline is more effective than bupropion or NRT in achieving abstinence from cigarette smoking 1. For patients with respiratory symptoms, prescribe appropriate treatments such as bronchodilators for cough or wheezing.
• Regular follow-up appointments are essential to monitor progress, adjust treatment as needed, and provide continued support. These interventions work by addressing both the physical nicotine dependence and the behavioral aspects of vaping, giving patients the best chance for successful cessation, as supported by the US Preventive Services Task Force recommendation statement 1.

From the FDA Drug Label

If you are using a non-nicotine stop smoking drug

Warnings If you are pregnant or breast-feeding, only use this medicine on the advice of your health care provider.

Ask a doctor before use if you have heart disease, recent heart attack, or irregular heartbeat.

When using this product do not smoke even when not wearing the patch.

The patient who vapes should be treated with caution and under the guidance of a healthcare provider. Nicotine replacement therapy or non-nicotine stop smoking drugs may be considered as part of a comprehensive treatment plan.

• Key considerations for treating a patient who vapes include:
  • Assessing the patient's overall health and medical history
  • Evaluating the patient's nicotine dependence and withdrawal symptoms
  • Developing a personalized quit plan that may include medication, counseling, and support
  • Monitoring the patient's progress and adjusting the treatment plan as needed
• Important warnings and precautions to consider when treating a patient who vapes include:
  • Nicotine overdose symptoms, such as nausea, vomiting, dizziness, weakness, and rapid heartbeat
  • Irregular heartbeat or palpitations
  • Skin redness or swelling caused by nicotine replacement therapy patches
  • Vivid dreams or other sleep disturbances 2 3

From the Research

Treatment Options for Patients Who Vape

To treat a patient who vapes, several options can be considered, including pharmacological interventions, behavioural interventions, or a combination of both 4.

• Pharmacological Interventions:
  • Combination nicotine replacement therapy (NRT) may be beneficial, but the evidence is very low-certainty due to imprecision and risk of bias 4.
  • Varenicline has been shown to increase vaping cessation rates at six months, although the evidence is low certainty due to imprecision 4.
  • Cytisine did not report vaping cessation rates at six months or longer in the available study 4.
• Behavioural Interventions:
  • Reducing nicotine concentration and vaping behaviour may increase vaping cessation compared to minimal support, but the evidence is very low-certainty due to imprecision and risk of bias 4.
  • Text message-based interventions may increase vaping cessation rates compared to control in 13- to 24-year-olds, with low-certainty evidence 4.
• Other Interventions:
  • A comprehensive mobile vaping cessation program has shown promise in helping adults who vape daily to quit, with high engagement and retention rates, and improvements in vaping attitudes and behaviour 5.
  • Nicotine replacement therapy, bupropion, nortriptyline, clonidine, and varenicline are all effective smoking cessation interventions, although insufficient evidence exists to recommend one over another 6.

Considerations for Healthcare Professionals

Healthcare professionals should be prepared to provide smokers with evidence-based treatment and referrals to trained cessation counselors 7. They should also be prepared to discuss the use of nicotine vaping products, particularly if smokers are seeking advice about these products or have failed to quit with other methods 7.

• Assessment and Support:
  • Assess the patient's motivation to quit vaping and provide support and guidance throughout the quitting process.
  • Offer a combination of pharmacological and behavioural interventions, tailored to the patient's needs and preferences.
• Monitoring and Follow-up:
  • Monitor the patient's progress and provide ongoing support and encouragement.
  • Follow up with the patient regularly to assess their quit status and provide additional support as needed.