From the Guidelines
The most effective treatment for smoking cessation in patients with schizophrenia is a combination of pharmacotherapy, such as varenicline or bupropion, and behavioral support, including cognitive-behavioral therapy. According to the most recent and highest quality study, 1, the American Psychiatric Association recommends a comprehensive and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments.
When it comes to smoking cessation, the European guidelines on cardiovascular disease prevention in clinical practice, 1, suggest that pharmacological aid, such as nicotine replacement therapy (NRT), varenicline, or bupropion, consistently improves quit rates. Varenicline has been shown to increase the chances of successful long-term smoking cessation between two- and three-fold compared with pharmacologically unassisted quit attempts.
Some key points to consider when treating smoking cessation in patients with schizophrenia include:
- Monitoring psychiatric symptoms closely during cessation attempts, as nicotine withdrawal may exacerbate schizophrenia symptoms
- Considering potential drug interactions between cessation medications and antipsychotics
- Using a gradual reduction approach rather than abrupt cessation, which is often better tolerated in this population
- Providing longer treatment durations (up to 6 months) for successful long-term abstinence
- Combining pharmacological approaches with cognitive-behavioral therapy specifically tailored for patients with schizophrenia, addressing their unique challenges, as recommended by 1.
It's also important to note that the treatment of tobacco dependence should be guided by the patient’s medical history, the presence of contraindications, the preferences of the patient and clinician, and the cost of therapy, as suggested by 1.
Overall, a comprehensive treatment plan that includes pharmacotherapy, behavioral support, and close monitoring of psychiatric symptoms is the most effective approach for smoking cessation in patients with schizophrenia.
From the FDA Drug Label
Varenicline is a nicotinic receptor partial agonist indicated for use as an aid to smoking cessation treatment. Consider a gradual approach to quitting smoking with varenicline tablets for patients who are sure that they are not able or willing to quit abruptly. WARNINGS AND PRECAUTIONS • Neuropsychiatric Adverse Events: Postmarketing reports of serious or clinically significant neuropsychiatric adverse events have included changes in mood (including depression and mania), psychosis, hallucinations, paranoia, delusions, homicidal ideation, aggression, hostility, agitation, anxiety, and panic, as well as suicidal ideation, suicide attempt, and completed suicide.
The recommended treatment for smoking cessation in patients with schizophrenia is varenicline, but it should be used with caution due to the potential for neuropsychiatric adverse events. Patients with schizophrenia should be closely monitored for the occurrence of such symptoms and instructed to discontinue varenicline and contact a healthcare provider if they experience such adverse events 2.
From the Research
Smoking Cessation in Schizophrenia
- Smoking cessation is crucial for patients with schizophrenia due to the high prevalence of smoking in this population and its associated health risks 3, 4, 5, 6.
- Various studies have investigated the effectiveness of different smoking cessation strategies in patients with schizophrenia.
Recommended Treatments
- Bupropion has been shown to be effective in increasing smoking abstinence rates in patients with schizophrenia, with a significant reduction in expired breath carbon monoxide levels and no worsening of psychotic symptoms 3, 4.
- Varenicline, in combination with behavioral treatment, is also recommended for smoking cessation in patients with schizophrenia spectrum disorders 5, 6.
- Nicotine replacement therapy (NRT) can be used in combination with bupropion or varenicline to enhance smoking cessation outcomes 4, 5, 6.
Safety and Efficacy
- Studies have found that smoking cessation pharmacotherapies, including bupropion, varenicline, and NRT, are safe and effective for use in patients with schizophrenia, with no evidence of worsening psychiatric symptoms or increased risk of psychiatric adverse events 4, 5, 6.
- Atypical antipsychotics may enhance smoking cessation outcomes with bupropion, and clozapine may reduce smoking consumption in schizophrenia patients 3, 4.
Alternative Approaches
- Electronic cigarettes (e-cigarettes) have been investigated as a potential tool for smoking reduction and cessation in schizophrenic smokers, with some studies showing promising results, including reduced cigarette consumption and abstinence rates without significant side effects 7.