From the Guidelines
Smoking cessation treatment should involve a combination of behavioral support and medication therapy, with first-line medications including nicotine replacement therapy (NRT), varenicline, or bupropion SR, as recommended by the US Preventive Services Task Force 1.
Key Components of Smoking Cessation Treatment
- Behavioral support: counseling (individual, group, or telephone) to set a quit date, identify triggers, develop coping strategies, and create a supportive environment
- Medication therapy: NRT (patches, gum, lozenges, inhalers, or nasal spray), varenicline (Chantix/Champix), or bupropion SR (Zyban)
- Treatment duration: typically 8-12 weeks, with longer durations for those who need additional support
Medication Options
- NRT: can be used in combination (e.g., patch plus gum or lozenge) for better results
- Varenicline: starting at 0.5mg once daily for 3 days, then 0.5mg twice daily for 4 days, then 1mg twice daily for 12 weeks
- Bupropion SR: 150mg once daily for 3 days, then 150mg twice daily for 7-12 weeks
Importance of Combination Therapy
- Combining behavioral and pharmacotherapy interventions increases cessation rates compared to using either approach alone 1
- Using two types of NRT or combining NRT with bupropion SR may be more effective than using a single type of medication 1
Follow-up and Support
- Regular follow-up (in-person or by phone) is recommended to monitor progress and provide support
- Brief slips or relapses are common, but do not necessarily indicate a need for an alternative intervention 1
From the FDA Drug Label
Varenicline is a nicotinic receptor partial agonist indicated for use as an aid to smoking cessation treatment. Begin varenicline tablets dosing one week before the date set by the patient to stop smoking. Alternatively, the patient can begin varenicline tablets dosing and then quit smoking between days 8 and 35 of treatment. Starting Week: 0.5 mg once daily on days 1 to 3 and 0.5 mg twice daily on days 4 to 7. Continuing Weeks: 1 mg twice daily for a total of 12 weeks. An additional 12 weeks of treatment is recommended for successful quitters to increase likelihood of long-term abstinence.
Smoking Cessation Treatment with Varenicline
- Varenicline is indicated for use as an aid to smoking cessation treatment 2.
- The recommended dosage is 0.5 mg once daily on days 1 to 3,0.5 mg twice daily on days 4 to 7, and 1 mg twice daily for a total of 12 weeks 2.
- An additional 12 weeks of treatment is recommended for successful quitters to increase likelihood of long-term abstinence 2.
- Patients should be provided with appropriate educational materials and counseling to support the quit attempt 2.
From the Research
Smoking Cessation Treatment Options
- Smoking cessation is a challenging process, and various treatment options are available to help individuals quit smoking 3, 4, 5, 6, 7.
- Pharmacologic smoking cessation aids, such as nicotine replacement therapy (NRT), bupropion, and varenicline, are recommended for all smokers who are trying to quit, unless contraindicated 3.
- Behavioral interventions, including counseling, are also effective in helping people to stop smoking, and combining both treatment approaches is recommended where possible 4, 7.
Effectiveness of Different Treatments
- Nicotine replacement therapy (NRT) has been shown to increase smoking cessation rates by approximately 1.5- to 2-fold after 12 months 5.
- Bupropion is effective for smoking cessation, and its effectiveness is improved by a moderate level of counseling 5.
- Varenicline, a partial agonist at nicotinic alpha4beta2 receptors, has been shown to be at least as good as and probably more effective than bupropion for smoking cessation 5.
- Combination pharmacotherapy, including NRT and non-nicotine preparations, may be helpful for highly nicotine-dependent smokers, patients who have failed with monotherapy, and patients with breakthrough cravings 3, 6.
Combination of Pharmacotherapy and Behavioral Interventions
- Combining pharmacotherapy and behavioral support increases smoking cessation success compared to a minimal intervention or usual care 7.
- The size of the treatment effect with different combinations and in different settings and populations is unclear, but the evidence suggests that combining both treatment approaches is beneficial 7.
- Interventions that combine pharmacotherapy and behavioral support are more effective in healthcare settings than in community-based settings 7.