Review: Pharmacotherapy for smoking cessation
Abstract
Abstract:
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.
Keywords: smoking cessation; nicotine replacement therapy; varenicline; bupropion: e-cigarettes
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