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Three forms of medicine (nicotine replacement therapy, varenicline and bupropion) are licensed and available in Australia to assist smoking cessation. These medicines have been shown to assist smoking cessation in meta-analyses of randomised clinical trials.96–99
Pharmacotherapy should be recommended to all dependent smokers who express an interest in quitting, except where contraindicated.7,11 Some people prefer to try to quit without assistance and this choice should be respected, however, best results are achieved when medicines are used in combination with counselling and support,62,65 although there is some evidence that nicotine replacement therapy (NRT) can increase quit rates with or without counselling.98 The choice of pharmacotherapy is based on clinical suitability and patient choice (Figure 2 ).
Patients quitting smoking with any method are at some risk of increased psychological stress during the quitting process, but the risk is higher for those with a history of mental illness. Clinicians should monitor patients with mental illness more closely and advise prompt reporting of adverse events.