An update on the pharmacotherapeutic interventions for smoking cessation

ABSTRACT

Introduction: Cigarette smoking can damage every organ in the body and is the leading known preventable cause of death globally. It is estimated that 70% of patients want to quit, and about 50% report a quit attempt in the past year, yet only 4-7% are successful. These low quit rates represent the importance of appropriate treatment for smoking cessation through behavioral and pharmacotherapeutic means.

Areas covered: Pharmacotherapy approximately doubles patients’ chances of quitting, and the first-line approved pharmacotherapetuic options include nicotine gum, lozenge, patch, nasal spray, and inhaler, sustained-release bupropion, and varenicline. Second-line therapies include nortriptyline and clonidine. Recent evidence suggests a potential role for cytisine and naltrexone. Healthcare providers play an important role in helping patients quit smoking; therefore, a clear understanding of appropriate dosing, regimen, technique, disadvantages, advantages, warnings/precautions, and contraindications for available pharmacotherapeutic options is essential.

Expert opinion: To improve chances of success, providers should consider patient preferences and prior experiences with quitting, provide medication-specific counseling for the selected therapy, and encourage adherence with the behavioral and pharmacotherapeutic treatment regimen.

KEYWORDS:

• Smoking cessation
• tobacco cessation
• nicotine replacement therapy
• varenicline
• bupropion
• nicotine lozenge
• nicotine gum
• nicotine patch
• nicotine nasal spray
• nicotine inhaler

Article highlights

• Tobacco smoke damages every organ in the body, and it is estimated that 6 million lives are lost annually due to tobacco-related disease, and 100 million lives lost in the 20th century. Cigarette smoking is the leading cause of preventable death globally, and all patients who smoke should be encouraged to quit.

• One or more first-line medications (nicotine gum, lozenge, patch, nasal spray, and inhaler, sustained-release bupropion, and varenicline) is recommended in combination with behavioral counseling for patients attempting to quit smoking.

• Clinicians should be aware of the appropriate dosing, advantages, and disadvantages, including adverse effects, precautions/warnings, and contraindications for each of the seven FDA-approved medications for smoking cessation.

• Medications may be used in combination, and this approach should be considered for all patients who have failed prior quit attempts using monotherapy with appropriate dosing and regimen adherence.

• Second-line agents (nortriptyline and clonidine) might be considered for patients who are unable to take first-line therapies or who have unsuccessfully tried the first-line therapies despite appropriate dosing and regimen adherence.

This box summarizes key points contained in the article

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.