Smoking medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview[edit | edit source]

Some general principles including the 5 As (ask, Assess, Advise, Assist and Arrange follow-up), non-pahramcological strategies like nicotine gum and nicotine patch and pharmacological strategies including bupropion, varenicline, inhalers and nasal sprays can be used to help quit smoking.^{[1][2][3][4][5]}

Medical Therapy[edit | edit source]

General Principles[edit | edit source]

The 5As are an evidence-based framework for structuring smoking cessation in health care settings. The 5As include: Ask, Assess, Advise, Assist and Arrange follow-up.^{[1][2][3][4][5]}

Pharmacological Therapy[edit | edit source]

First-line pharmacotherapy includes the multiple forms of nicotine replacement therapy (patch, nasal spray, losenge, gum, inhaler), sustained- release bupropion hydrochloride, and varenicline. Second line therapy includes clonidine and nortriptyline and have been found to be efficacious.^[6]
The following is a description of the various treatment modalities available:^[7]

• Sustained release bupropion hydrochloride:
  • Dose: 150 mg every morning for 3 days, then 150 mg twice daily.
  • Duration: The duration of treatment is 7–12 weeks followed by a maintenance therapy up to 6 months.
  • Adverse effects: Insomnia and dry mouth.
  • Treatment must be initiated 1-2 weeks prior to the quit date.
• Nicotine gum:
  • Dose: 1–24 cigarettes/day: 2mg gum (up to 24 pieces/day). ≥ 25 cigarettes/day: 4 mg gum (up to 24 pieces/day).
  • Duration: Up to 12 weeks
  • Adverse effects: Mouth soreness and dyspepsia
• Nicotine inhaler:
  • Dose: 6–16 cartridges/day
  • Duration: Up to 6 months
  • Adverse effects: Local irritation of mouth and throat
• Nicotine lozenges:
  • Dose: Time to 1st cigarette > 30 min: 2 mg lozenge. Time to 1st cigarette ≤ 30 min: 4 mg lozenge. 4–20 lozenges/day can be used based on the need.
  • Duration: Up to 12 weeks
  • Adverse effects: Nausea and heartburn
• Nicotine nasal spray:
  • Dose: 8–40 doses/day
  • Duration: 3–6 months
  • Adverse effects: Nasal irritation
• Varenicline:
  • Dose: 0.5 mg/day for 3 days followed by 0.5 mg twice/day for 4 days. Then, 1 mg twice/day
  • Duration: 3–6 months
  • Adverse effects: Nausea, trouble sleeping, vivid/strange dreams and depressed mood

Effect of Smoking Cessation on various Risks[edit | edit source]

• Quitting smoking cuts cardiovascular risks. Just 1 year after quitting smoking, your risk for a heart attack drops sharply.
• Within 2 to 5 years after quitting smoking, your risk for stroke may reduce to about that of a nonsmoker’s.
• If you quit smoking, your risks for cancers of the mouth, throat, esophagus, and bladder drop by half within 5 years.
• Ten years after you quit smoking, your risk for lung cancer drops by half.

References[edit | edit source]

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