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Pharmacotherapy for smoking cessation in adults

Author
Nancy A Rigotti, MD
Section Editors
James K Stoller, MD, MS
Mark D Aronson, MD
Deputy Editor
H Nancy Sokol, MD

INTRODUCTION

Pharmacotherapy for smoking cessation aims to reduce the symptoms of nicotine withdrawal, thereby making it easier for a smoker to stop the use of cigarettes. The main medications that have demonstrated efficacy as smoking cessation aids include nicotine replacement, varenicline, and bupropion [1]. Smokers who wish to quit should be managed with a combination of behavioral therapy and pharmacotherapy, as the combination of counseling and pharmacologic therapies produces higher quit rates than either one alone [2].

Pharmacologic options to help patients stop smoking are reviewed here. An overview of smoking cessation management and behavioral therapies for smoking cessation are discussed separately. (See "Overview of smoking cessation management in adults" and "Behavioral approaches to smoking cessation".)

FIRST-LINE MEDICATIONS

Smoking cessation clinical guidelines from the US Public Health Service (2008) and the US Preventive Services Task Force (2015) consider the following drugs to be first-line agents for tobacco cessation: nicotine replacement therapy (NRT; transdermal nicotine patch, nicotine gum, lozenge, inhaler, and/or nasal spray), varenicline, and bupropion (table 1) [3-5]. Other medications have been evaluated for smoking cessation but have less established efficacy than first-line agents. (See 'Other medications' below.)

With a few exceptions, choice of first-line medication is generally based on patient preference after discussion with a clinician. (See 'Initiating therapy' below.)

Combination nicotine replacement therapy — The goal of NRT is to provide nicotine to a smoker without using tobacco, thereby relieving nicotine withdrawal symptoms as the smoker breaks the behavior of cigarette smoking. Three NRT products are available in the United States without a prescription (patch, lozenge, and gum). Two (nasal spray and oral inhaler) are available by prescription only. A nicotine mouth spray and sublingual tablet are available in some countries, but are not licensed for sale in the United States.

                                    

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Literature review current through: Nov 2016. | This topic last updated: Wed Jul 06 00:00:00 GMT 2016.
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