Smoking Cessation: Pharmacologic Options

Amy Treece, MD

1. Nicotine Replacement Therapy

- Suppress abstinence syndrome (irritability, poor concentration, hunger, anxiety, GI upset, sleep disturbances)

- Reduce craving (slow onset, longer acting)

- Use 2-3 months, then taper.

- NO SMOKING (nicotine overdose = HA, dizziness, GI upset)

Nicotine Patch (OTC)

- 16 hrs vs. 24 hrs/day (sleep disturbances vs. treating early morning craving)

- 7mg, 14mg (<1/2 pk/day), or 21mg (>1/2pk/day)

COMMON SIDE EFFECTS: skin irritation, sleep disturbance, palpitations, HTN

Nicotine Gum (OTC)

- 2mg or 4mg, dose variable

- Target 9-24 pieces/day. (1 gum/1-2hours)

- Avoid acidic beverages (coffee, wine, juice soda)

- “Chew and Park” technique

Others: nicotine inhaler/lozenge/nasal spray (Rx required)

2. Bupropion (Wellbutrin, Zyban)

-Inhibits reuptake of dopamine and norepinephrine

-Anti-depressant effects

-May combine with NRT

DOSING:

a) Start 1 week prior to QUIT DATE

b) 150mg/day x 3 days, then 150mg bid

COMMON SIDE EFFECTS:

-seizures (rare), sleep disturbances, nausea, dry mouth, LESS weight gain

3. Varenicline (Chantix)

-ά4β2 Nicotinic Acetylcholine Receptor Partial Agonist (competitive, high affinity, selective)

DOSING:

a) Start 1 week prior to QUIT DATE

b) 0.5mg daily x 3 days, 0.5mg bid x 4 days, then 1mg bid.

COMMON SIDE EFFECTS:

- nausea (30%, improves with time), abnormal dreams, GI upset, weight gain