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Clinical guidelines

Supporting smoking cessationA guide for health professionals

Pharmacotherapy for smoking cessation

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. 

Click on image to resize (open PDF version)07  Figure 2. Pharmacotherapy Treatment Algorithm

References

  1. Zwar N, Richmond R, Borland R, Stillman S, Cunningham M, Litt J. Smoking cessation guidelines for Australian general practice: practice handbook. Canberra: Australian Government Department of Health and Ageing, 2004.
  2. Fiore MC, Jaén CR, Baker TB, Bailey WC, et al. for the Guideline Panel. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, May 2008. Available at http://www.ncbi.nlm.nih.gov/books/NBK63952/ [accessed 20 March 2011].
  3. Chapman S, MacKenzie R. The global research neglect of unassisted smoking cessation: causes and consequences. PloS Med 2010;7:e1000216.
  4. Shiffman S, Brockwell SE, Pillitteri JL, Gitchell JG. Use of smoking-cessation treatments in the United States. Am J Prev Med 2008;34:102–11.
  5. Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2012 Apr 18;4:CD006103.
  6. Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2007, Issue 1. Art. no. CD000031.
  7. Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2008, Issue 1. Art. no. CD000146.
  8. Aubin H-J, Bobak A, Britton JR, et al. Varenicline versus transdermal nicotine patch for smoking cessation results from a randomised open-label trial. Thorax 2008;63:717–24.
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