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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]

Nausea, insomnia, headache, flatulence. May be associated with neuro- psychiatric effects — depression, suicidality and homicidal ideation. Also exercise cau- tion in those with diabetes and operat- ing heavy machinery.

 

 

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)