Smoking cessation / tobacco use disorder
- Behavioral support + medication works best
- Varenicline is the most effective single drug
- Combination nicotine replacement is highly effective
- Bupropion SR is another first-line option
- Set a quit/reduction plan and follow up repeatedly
- Smoking cessation can raise CYP1A2 drug levels
Use at a glance
- Behavioral support + medication works best
Treatment options
- Bupropion SR is another first-line option
Other treatment options
- Varenicline is the most effective single drug
- Combination nicotine replacement is highly effective
- Smoking cessation can raise CYP1A2 drug levels
Monitoring / follow-up
- Set a quit/reduction plan and follow up repeatedly
Key points
- Pharmacotherapy + behavioral support: safe, effective cessation
- NRTs roughly equivalent; patch + rapid-onset NRT beats either alone
- Bupropion SR ≈ single NRT; varenicline most effective monotherapy, ≈ combination NRT
- Optimal duration unclear; ≥3-6 months of effective therapy for most
- E-cigarettes: efficacy and safety for cessation unestablished
Nonpharmacologic therapies
- Behavioral counseling
- Abrupt cessation
- Gradual pre-quit reduction
- Financial incentives
- Mailed free nicotine patches
- Reduced-nicotine cigarettes
- Electronic cigarettes
Pearls
- OTC patch, gum, lozenge as effective as Rx inhaler or spray
- Remove patch at bedtime if insomnia or vivid dreams
- Varenicline and bupropion no longer carry neuropsychiatric boxed warning
- Rapid-onset NRT alone: dose on a schedule, not PRN
- Taper NRT; varenicline and bupropion can stop without taper
Self-check
- Which single drug is most effective for smoking cessation?
Varenicline. - Which antidepressant is a first-line smoking-cessation option?
Bupropion SR.
Drugs used for this (6)
All clinical uses · Open Smoking cessation / tobacco use disorder in the interactive console ↗