patients attending hospitals who do not have C/I should be offered at least temporary nicotine replacement Rx whilst they are in hospital to reduce nicotine withdrawal agitation and requests to go outside for a smoke
most hospitals now do not allow patients under mental health assessment orders to go outside even with a hospital escort die to the potential for harm to the escort, or the patient absconding
Pathophysiology
a 2025 study suggests that striatal cholinergic interneurons play a key role in mediating some of the withdrawal symptoms such as tremors and that this can be reduced by use of procyclidine which inhibits these neurons 1)
Nicotine replacement Rx options
a long acting 21mg 24hr patch (can be removed overnight if patient suffers nocturnal symptoms from the patch)
PLUS a short acting Rx such as:
2mg lozenge (must not be chewed and must be kept in mouth for 20 minutes, max. 12 per 24hrs), or,
2mg gum (chew, park, chew method for 30 minutes, max. 12 per 24hrs), or,
15mg cartridge inhaler (lasts 40 minutes, max. 12 per 24hrs, not for asthmatics)