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First line options are medicines that have been shown to be effective and are licensed for smoking cessation. In Australia these are NRT (brands include Chemist’s Own Nicotine, Nicabate CQ®, Nicorette®, Nicotinell®, QuitX® and others), varenicline (brand name Champix®) and sustained release preparations of bupropion hydrochloride (brand names Buproprion-RL™, Clorprax®, Prexaton and Zyban SR®).
From current available evidence, varenicline is the most effective form of single pharmacotherapy for smoking cessation, but this is based on a limited number of comparison studies.96,100,101 A Cochrane network analysis concluded that combinations of nicotine replacement therapy and varenicline are the most effective quitting aids and are of similar efficacy.102 It has been shown that varenicline is more effective than bupropion in a number of studies. Head to head comparisons between bupropion and NRT monotherapy have shown these medicines are equivalent to each other in efficacy.102
Clinical assessment, context and patient preference are important in choosing the pharmacotherapy that is most likely to assist the smoker in an attempt to quit. Consideration should be given to factors such as the potential for adverse effects, possible drug interactions, previous experience with pharmacotherapy convenience and cost.103 Some smokers may prefer to use one or more forms of NRT, while others may prefer the non-nicotine options. An advantage of NRT is that it can be purchased without a prescription. One form of NRT (patch) is now subsidised by the PBS if provided in combination with counselling.
Evidence
Pharmacotherapy with nicotine replacement therapy, varenicline or bupropion is an effective aid to assisting motivated smokers to quit. Level I
Recommendation
In the absence of contraindications, pharmacotherapy should be offered to all motivated smokers who have evidence of nicotine dependence. Choice of pharmacotherapy is based on clinical suitability and patient choice. Strength A
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