Treatment

Nicotine Replacement Therapies
Non-nicotine Medicines

Different ways to stop smoking are effective for different patients. Some smokers can quit with the help of counseling, while others may need nicotine replacement therapy or non-nicotine medicines to help them quit. Since patients can improve their health in many ways by quitting smoking, medicines are often prescribed with careful monitoring to help them succeed.

Nicotine replacement therapy may help with the withdrawal symptoms that patients experience when trying to stop smoking. Nicotine products include:

• Nicotine inhalers.

• Nicotine gum.

• Nicotine lozenges.

• Nicotine patches

A physician should be consulted before starting any form of treatment, and the following groups should take special precautions:

• Patients who are pregnant or nursing should get advice from a health care professional before using nicotine replacement products.

• Patients who continue to smoke, chew tobacco, or use snuff should not use nicotine replacement products.

• Patients aged less than 18 years and those who have the following conditions should check with a physician before using nicotine replacement products:
  • Heart disease or an irregular heartbeat.
  • High blood pressure not controlled with medicine.
  • Esophagitis or peptic ulcer disease.
  • Diabetes treated with insulin.
  • Depression or asthma treated with prescription medicines.

Non-nicotine medicines that have been studied to help people quit smoking include:

• Varenicline (also called Chantix), a drug approved by the Food and Drug Administration (FDA) for smoking cessation that acts the same way nicotine acts in the brain. This results in less craving and fewer nicotine withdrawal symptoms. In June 2011, the FDA warned that varenicline may increase the risk of cardiovascular (heart and blood vessel) adverse events in patients with cardiovascular disease.

• Bupropion (also called Zyban), the only antidepressant approved by the FDA for smoking cessation.

• Fluoxetine (also called Prozac), an antidepressant shown to be effective in smoking cessation.

The FDA has directed manufacturers of bupropion and varenicline to add a boxed warning about the risk of depression, suicide, and other psychiatric events in patients who take these drugs, including:

• Psychosis.
• Hallucinations.
• Paranoia.
• Agitation.
• Anxiety.
• Panic.

These events have been reported in patients with or without a history of psychiatric illness. It is not known whether nicotine withdrawal is a factor in these psychiatric events. Fluoxetine has a boxed warning about an increased risk of suicide in young adults aged less than 25 years. (See the Depression and Suicide section in the PDQ summary on Pediatric Supportive Care.)

All patients taking these drugs, especially those with a history of psychiatric illness, should be closely monitored during smoking cessation.

The FDA advises that the important health benefits of quitting smoking should be weighed against the small but serious risk of problems with the use of these drugs.