Smoking Cessation

Nicotine Addiction:

  • Pharmacotherapy
    • Combinations of Nictoine Replacement Therapy
    • Varenicline 
      • Both of these are equally effective therapy 
    • Other
      • Head-to-head study of Bupropion and Nictotine replacement showed equal efficacy
  • Nicotine replacement* gum : 1 piece (2 mg) whenever urge to smoke up to 30 pieces/day;continuous use for >3 months not recommended
  • Nicotine 24-hour patch: 
    • 21-mg patch/y once daily for 4–8 weeks (remove and replace other forms of nicotine every 24 hours). 
    • Then 14-mg replacement patch/day for 2–4 weeks followed by 
    • 7-mg replacement patch/day for 2–4 weeks
      • Adults weighing less than 100 pounds, smoking fewer than and risk for recurrent coronary events or 10 cigarettes/day and/or with cardiovascular disease 
        • 14-mg patch/y once daily for 4–8 weeks (remove and replace other forms of nicotine every 24 hours). 
        • Then 7-mg replacement patch/day for 2–4 weeks 
  • Nicotine Spray: 
  • Nicotine Inhaler:
  • Nicotine Lozenges: 
  • Bupropion: (Up-to-date)
    • Initial: 150 mg once daily for 3 days; increase to 150 mg twice daily; treatment should continue for 7 to 12 weeks (maximum dose: 300 mg daily).
    • Therapy should begin at least 1 week before target quit date. Target quit dates are generally in the second week of treatment. If patient successfully quits smoking after 7 to 12 weeks, may consider ongoing maintenance therapy based on individual patient risk:benefit.
    • Efficacy of maintenance therapy (300 mg daily) has been demonstrated for up to 6 months. Conversely, if significant progress has not been made by the seventh week of therapy, success is unlikely and treatment discontinuation should be considered.
  • Varenicline: (Up-to-date)
    • Initial: Days 1 to 3: 0.5 mg once daily; Days 4 to 7: 0.5 mg twice daily
    • Maintenance (≥ Day 8): 1 mg twice daily for 11 weeks
    • Start 1 week before target quit date. Alternatively, patients may consider setting a quit date up to 35 days after initiation of varenicline 
Supporting smoking cessation BMJ 2014
Smoking Cessation AAFP 2012
e-Cigarettes (for Patients) JAMA 2014
Electronic Cigarettes (The Medical Letter on Drugs and Therapeutics) JAMA 2014