SHM's Clinical Quick Talks-Tobacco Cessation Medications

Pdf Summary
Tobacco cessation is a vital public health goal as cigarette smoking remains the leading cause of disease, disability, and death in the United States. Many adult smokers desire to quit, and there are several effective methods and medications available to assist them.<br /><br />Nicotine replacement therapy (NRT) is a commonly used method to reduce withdrawal symptoms and cravings. Short-acting NRT options include nicotine gum, mini lozenges, nasal spray, and nasal inhalers. These methods are most effective when used frequently and in combination with long-acting NRT. The long-acting option is the nicotine patch, which delivers a sustained release of nicotine throughout the day.<br /><br />In addition to NRT, there are non-nicotine replacement therapy options available. Varenicline (Chantix) is a medication that has shown superior results compared to placebo, bupropion, and NRT. It works by reducing the pleasure derived from nicotine consumption. Bupropion (Wellbutrin) is another medication with similar efficacy to the nicotine patch, and combining it with NRT can enhance effectiveness.<br /><br />When approaching patients who smoke, healthcare providers should employ the evidence-based 5A's approach: Ask about smoking history, Advise to quit, Assess readiness, Assist with behavioral support and medication, and Arrange follow-up. The specific treatment approach will vary depending on the patient's readiness to quit. Patients who are ready to quit can be referred to a quit line and provided with medications such as varenicline or combination NRT. Patients not ready to quit should be educated about the risks and benefits and encouraged to protect others from secondhand smoke.<br /><br />For patients who have reduced but not quit smoking, additional medications or combinations can be considered. In cases of relapse, patients should be encouraged to make another attempt to quit, with intensified behavioral support and potentially additional medications.<br /><br />It is important to note that e-cigarettes, although marketed as smoking cessation aids, have limited long-term safety data and can actually lead to conventional cigarette use. Healthcare providers should counsel against dual use and explain the risks of increased nicotine concentration and dependence.<br /><br />Overall, tobacco cessation requires a comprehensive approach that combines behavioral support and various pharmacologic therapies. Continued pharmacotherapy for at least three months is recommended to reduce the risk of relapse. Even smoking a small number of cigarettes per day can have detrimental health effects, and quitting is always beneficial for overall health and wellbeing.
Asset Subtitle
Travis Douglass
Keywords
tobacco cessation
cigarette smoking
NRT
nicotine patch
Varenicline
bupropion
5A's approach
quit line
secondhand smoke
e-cigarettes