Treatment Recommendations for Smoking

The Clinical Practice Guideline Treating Tobacco Use and Dependence: 2008 Update states, “All smokers trying to quit should be offered medication, except when contraindicated or for specific populations for which there is insufficient evidence of effectiveness,” i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents (for recommendations to treat pregnant women, smokeless tobacco users, light smokers and adolescents go to Treatment Recommendations for Special Populations). Appropriate use of tobacco dependence medications reduces withdrawal symptoms and nearly doubles the chances of success for a given quit attempt. Delivering such treatments is cost-effective and is a key part of a multi-faceted approach to help patients stop smoking.

There are seven first-line medications that reliably increase long-term smoking abstinence rates.

Nicotine

  • Nicotine gum
  • Nicotine inhaler
  • Nicotine lozenge
  • Nicotine nasal spray
  • Nicotine patch

Non-nicotine

  • Bupropion SR
  • Varenicline

Clinicians should also consider the use of certain combinations of medications identified as effective in the Guideline.

  • Long-term (>14 weeks) nicotine patch + other NRT
  • The nicotine patch + the nicotine inhaler
  • The nicotine patch + Bupropion SR

TOOLS:

Key Point: Encourage patients making a quit attempt to use both counseling and medication. Counseling and medication are effective when used by themselves for treating tobacco dependence. However, the combination of counseling and medication is more effective than either one alone.