First line pharmacotherapy options
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.
Pharmacotherapy with nicotine replacement therapy, varenicline or bupropion is an effective aid to assisting motivated smokers to quit. Level I
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
- Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2012 Apr 18;4:CD006103.
- Wu P, Wilson K, Dimoulas P, Mills EJ. Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. BMC Public Health 2006;6:300.
- National Institute for Health and Clinical Excellence. Varenicline for smoking cessation. NICE technology appraisal guidance 123. London: NICE, July 2007. Reviewed May 2010.
- Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013;5:CD009329.
- National Prescribing Service. Varenicline (Champix) for smoking cessation. NPS Radar April 2011. Available at www.nps.org.au/health_professionals/publications/nps_radar/2011/april_2011/varenicline [accessed 27 April 2010].