Review: Pharmacotherapy for smoking cessation

  • Chok Limsuwat
  • Shigeki Saito
  • Karin Halvorson
Keywords: smoking cessation, nicotine replacement therapy, varenicline, bupropion, e-cigarettes


Smoking is associated with numerous cancers and atherosclerosis. Smoking cessation
has substantial potential in reducing morbidity and mortality worldwide. The initial steps “5 A’s”
(Ask, Advise, Assess, Assist, Arrange) should be applied in all patients. Behavioral counseling
and pharmacotherapy are both effective, but the combination of the two is more effective than
either alone. The first-line pharmacotherapy includes nicotine replacement, bupropion, and
varenicline. Nicotine replacement therapy (NRT) consists of long-active formulations, such as
in a patch, and short-acting formulations such as in gum, lozenge, inhaler, and nasal spray. As
compared to placebo, NRT increases the chances of quitting smoking. Nicotine replacement
therapy does not increase cardiovascular risk and is safe in patients with cardiovascular
disease. Sustained-release bupropion is more effective than nicotine patches and can be
combined with nicotine patches. Buprenorphine is generally well tolerated, except that it lowers
seizure threshold and is contraindicated in patients with seizure disorders. Varenicline also
significantly improves the success rate of smoking cessation. The latest evidence suggests
that varenicline is not associated with an increased risk of neuropsychiatric or cardiovascular
events. In conclusion, the use of NRT (nicotine patch + nicotine gum/lozenge/inhaler/spray),
bupropion (with NRT), or varenicline is strongly recommended for smoking cessation, unless
they are contraindicated.


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How to Cite
Limsuwat, C., Saito, S., & Halvorson, K. (2018). Review: Pharmacotherapy for smoking cessation. The Southwest Respiratory and Critical Care Chronicles, 6(25), 31-37.