What is the treatment plan for Nicotine (nicotinic acetylcholine receptor) use disorder?

From the Guidelines

A comprehensive plan for tobacco use disorder should begin with a combination of behavioral support and pharmacotherapy, prioritizing the use of varenicline or combination nicotine replacement therapy (NRT) as the most effective options, as supported by the most recent and highest quality study 1.

Key Components of the Plan

• Set a quit date and prepare by identifying triggers and developing coping strategies
• Pharmacotherapy options:
  • Nicotine replacement therapy (NRT) in various forms: patches, gum, lozenges, inhalers, or nasal spray
  • Non-nicotine medications: bupropion SR and varenicline
• Combining NRT products or using NRT with bupropion can increase success rates
• Regular counseling sessions, either individual or group-based, significantly improve outcomes by providing emotional support and practical advice

Preferred Primary Therapy

• Combination NRT: Nicotine patch + short-acting NRT for cravings (lozenge/gum/inhaler/nasal spray)
• Varenicline

Addressing Withdrawal Symptoms

• Withdrawal symptoms like irritability, anxiety, and cravings typically peak within the first week and gradually subside
• The plan should address these symptoms and provide support and guidance to manage them

Importance of Behavioral Support

• Behavioral support is crucial in tobacco use disorder treatment, as it provides emotional support and practical advice to help individuals quit smoking
• Regular counseling sessions can significantly improve outcomes and increase the chances of long-term abstinence

Conclusion is not allowed, so the answer will continue with more details about the treatment.

The treatment of tobacco use disorder requires a comprehensive approach that addresses both the physical and psychological aspects of nicotine addiction.

• Varenicline is a first-in-class nicotine acetylcholine receptor partial agonist, designed to provide some nicotine effects and to block the effects of nicotine from cigarettes, discouraging smoking 1.
• The use of varenicline has been shown to increase the chances of successful long-term smoking cessation, and it is considered a preferred primary therapy option 1.
• Combination NRT is also a highly effective option, and it can be used in conjunction with varenicline or as an alternative therapy.
• The plan should be tailored to the individual's needs and preferences, and it should include regular follow-up and support to ensure long-term success 1.

From the FDA Drug Label

To obtain another source of data regarding the CV risk of varenicline, a cardiovascular endpoint analysis was added to the postmarketing neuropsychiatric safety outcome study along with a non-treatment extension In the parent study (N=8027), subjects aged 18 to 75 years, smoking 10 or more cigarettes per day were randomized 1:1:1:1 to varenicline 1 mg BID, bupropion SR 150 mg BID, nicotine replacement therapy (NRT) patch 21 mg/day or placebo for a treatment period of 12 weeks; they were then followed for another 12 weeks post-treatment. Table 17 Continuous Abstinence (95% confidence interval), Study in Patients with or without a History of Psychiatric Disorder Varenicline1 mg BID 38% BupropionSR150 mg BID 26% NRT 21mg/daywithtaper 26% Placebo 14% Weeks 9 through 12 Non-Psychiatric Cohort

The plan for tobacco use disorder is to use varenicline 1 mg BID for a treatment period of 12 weeks, with a follow-up of another 12 weeks post-treatment.

• Key points:
  • Varenicline is used for smoking cessation
  • Treatment duration: 12 weeks
  • Follow-up: 12 weeks post-treatment
  • Dosing: 1 mg BID
• Efficacy:
  • Continuous abstinence rates were higher for varenicline compared to bupropion, NRT, and placebo 2
  • Superior rate of CO-confirmed abstinence during weeks 9 through 12 and 9 through 24 compared to bupropion, nicotine patch, and placebo 2

From the Research

Treatment Options for Tobacco Use Disorder

• First-line pharmacotherapies for the treatment of tobacco use disorder include nicotine replacement therapy, bupropion sustained-release, and varenicline 3
• Varenicline and combination nicotine replacement therapy are the two most effective pharmacotherapies to treat tobacco dependence 4
• Nicotine replacement therapy, bupropion, and varenicline are approved by the US FDA as first-line treatments for nicotine dependence 5

Combination Therapies

• Combining a nicotine patch with other NRT products is more effective than use of a single NRT product 6
• Combining drugs with different mechanisms of action, such as varenicline and NRT, has increased quit rates in some studies compared with use of a single product 6
• The combination of medication and behavioral counseling is associated with a higher quit rate than brief advice or usual care 6

Behavioral Support

• Brief or intensive behavioral support can be delivered effectively in person or by telephone, text messages, or the internet 6
• The combination of a clinician's brief advice to quit and assistance to obtain tobacco cessation treatment is effective when routinely administered to tobacco users in virtually all health care settings 6

Safety of Treatments

• Nicotine replacement has few contraindications and side effects and can be recommended to almost all tobacco users 3
• Bupropion SR should be used with caution in patients with bipolar disorder or liver or kidney disease 3
• Varenicline can be used safely in patients with cardiovascular disease and stable psychiatric disease, with close clinical monitoring 3