Pharmacotherapy for smoking cessation
| pharmaco- therapy | dose | duration | efficacy vs. placebo (or [95% ci])* | major side- effects | |
|---|---|---|---|---|---|
| Nicotine replacement | |||||
| Patch | Available in 7, 14 and 21 mg Dose deter- mined by cigarettes per day (CPD); some will need >1 patch If > 14 CPD use 21 mg | 6 weeks on dose that controls withdrawal symptoms, then taper slowly (ap- prox. q2wks) | 1.77 [1.66 – 1.88]
1.81 [1.63 – 2.02]
at 6 – 12 months follow-up | Skin irritation
Nightmares | |
| Gum | Available in 2 or 4 mg
1 piece q1 – 2h prn to max 24/d | As above, best used in conjunction with patch for breakthrough cravings | 1.66 [1.52 – 1.81]
at 6 – 12 months follow-up | GI side- effects if nicotine is swallowed | |
| Inhaler | Cartridge con- tains 10 mg but delivers 4 mg nicotine
q1 – 2h prn |
| 2.14 [1.44 – 3.18]
at 6 – 12 months follow-up | Mouth and throat irrita- tion | |
| Bupropion (Zyban) | To be started 1 week before quit day
150 mg qd day 1 – 3
150 mg bid thereafter (may con- tinue qd if side-effects at bid dose) | Up to 12 weeks | 1.94 [1.72 – 2.19]
1.07 [0.87 – 1.32] | Insomnia, headache, jitteriness Seizure (rare) | |
| Varenicline (Champix) | Start 1 week before quit day
0.5 mg qd × 3d, then bid × 4d, 1 mg bid thereafter | 12 weeks +/- additional 12 weeks if effective | 2.82 [2.06 – 3.86] |
| |
Note: Recently, combination patch and gum has been approved for over-the counter use in Canada. Details can be found on the label of the product.
*(Cahill et al., 2010; Hughes et al., 2007; Stead et al., 2008; Fiore et al., 2008)