Pharmacotherapy

The most successful smoking cessation models combine brief counselling, support, and pharmacotherapy. The use of pharmacotherapy is widely accepted as an effective means to reduce the symptoms of nicotine withdrawal and aid in successful cessation.

There are currently seven FDA approved first-line medications used for smoking cessation: nicotine replacement therapy (NRT), and bupropion (Zyban) and varenicline (Chantix). Second-line pharmacotherapies include nortriptyline and clonidine.

What is nicotine replacement therapy?

Nicotine replacement therapy is a medically approved way to reduce withdrawal feelings and cigarette cravings by giving tobacco users a small, controlled amount of nicotine but none of the other dangerous chemicals found in cigarettes. This small amount of nicotine helps satisfy cravings and reduces the urge to smoke.

Many smokers find NRT helpful. Every person is different. But research shows that use of NRT can double the chances of successful quitting.

A variety of FDA-approved NRT products are available and are generally considered over the counter (OTC) medications (see information below). However, a smoker may need a prescription to have some NRT products covered by their health insurance plan.

How is NRT used?

NRT patches provide a slow, steady amount of nicotine over an extended period of time. Other NRT products, such as gum, lozenges and inhaler, give a fast burst of nicotine that can help get past short, strong cravings.

Many people find that combining the two – using patches in combination with a fast- acting form of NRT – offers the best chance of success.

Is NRT appropriate for everyone?

No. For persons with some serious medical conditions, NRT may not be appropriate. Talk with your health care provider.

Research and Guidelines

According to the National Institute on Drug Abuse, the majority of cigarette smokers would like to stop smoking, and each year about half will attempt to do so. Sadly, only about six percent are successful in a given year.

Research has shown that healthcare providers who intervene with smokers can have a positive impact on their cigarette-smoking behavior. Even brief advice and interaction with a physician – as short as three minutes – can make it much more likely that a patient will attempt to quit – and ultimately succeed!

Even so, providers may hesitate to initiate these discussions because of a seemingly low success rate with smokers. Moreover, some conversations may feel uncomfortable.

Research and guidelines can help healthcare providers become more conversant and confident when facilitating smoking cessation discussions. To this end, we offer the following authoritative references:

Nicotine Replacement Therapy/Prescription Medication

American Academy of Family Physicians (AAFP)

https://www.aafp.org/dam/AAFP/documents/patient_care/tobacco/pharmacologic-guide.pdf

Interventions for Smoking Cessation and Treatment for Nicotine Dependence

https://www.cdc.gov/tobacco/data_statistics/sgr/2020-smoking-cessation/pdfs/2020-cessation-sgr-chapter-6-508c.pdf

NIH

Combination Treatment for One Year Doubles Smokers’ Quit Rate | NIDA Archives (drugabuse.gov)

Archives of Internal Medicine

Nicotine inhaler and nicotine patch as a combination therapy for smoking cessation: a randomized, double-blind, placebo-controlled trial – PubMed (nih.gov)

JAMA

High-dose nicotine patch therapy. Percentage of replacement and smoking cessation – PubMed (nih.gov)

Psychological Dependence