What are the treatment options for smoking cessation (tobacco cessation)?

From the Guidelines

Smoking cessation treatment should always include a combination of pharmacologic therapy and behavior therapy, with the most effective pharmacotherapy agents being combination nicotine replacement therapy (NRT) and varenicline, as recommended by the US Preventive Services Task Force 1. The treatment options for smoking cessation include both medication and behavioral approaches. First-line medications include nicotine replacement therapy (NRT) in various forms: patches (21mg, 14mg, or 7mg daily, typically starting with higher doses for 4-6 weeks then tapering), gum (2mg or 4mg, used when craving occurs, up to 24 pieces daily), lozenges (2mg or 4mg, 1 piece every 1-2 hours), nasal spray (1-2 doses per hour), and inhalers (6-16 cartridges daily). Prescription medications include varenicline (Chantix, starting at 0.5mg daily for 3 days, then 0.5mg twice daily for 4 days, then 1mg twice daily for 12-24 weeks) and bupropion (Zyban, 150mg daily for 3 days, then 150mg twice daily for 7-12 weeks) 1. Some key points to consider when treating smoking cessation include:

• Combining medications (particularly different forms of NRT) with counseling provides the highest quit rates 1.
• High-intensity behavior therapy with multiple counseling sessions is most effective, but at least a minimum of brief counseling is highly recommended 1.
• Smoking status should be documented in the patient health record, and patient health records should be updated at regular intervals to indicate changes in smoking status, quit attempts made, and interventions utilized 1.
• Smoking relapse and brief slips are common, and providers should discuss this with patients and provide guidance and support to encourage continued smoking cessation attempts despite slips 1.
• Smoking cessation interventions should be offered and continued throughout the oncology care continuum, including during end-of-life care, with an emphasis on patient preferences and values 1. Using a combination of NRT products (in particular, combining short-acting plus long-acting forms of NRT) has been found to be more effective than using a single form of NRT, and varenicline appears to be more effective than NRT or bupropion SR 1. Behavioral support significantly improves success rates and includes individual or group counseling, quitlines (1-800-QUIT-NOW), mobile apps, and text message programs 1. Most people require multiple quit attempts before achieving long-term success, so persistence is key 1. These treatments work by addressing both the physical nicotine addiction and psychological habits associated with smoking, making the quitting process more manageable and increasing the chances of long-term abstinence 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. 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. Provide patients with appropriate educational materials and counseling to support the quit attempt.

The treatment options for smoking cessation (tobacco cessation) include:

• Varenicline tablets as an aid to smoking cessation treatment
• Gradual approach to quitting smoking for patients who cannot quit abruptly
• Educational materials and counseling to support the quit attempt 2

From the Research

Treatment Options for Smoking Cessation

The treatment options for smoking cessation can be categorized into two main types: pharmacological and non-pharmacological interventions.

• Pharmacological Interventions: These include medications such as nicotine replacement therapy (NRT), varenicline, bupropion, and cytisine 3, 4, 5. These medications have been proven to be effective and safe in helping smokers quit, even in patients with chronic cardiovascular disease.
• Non-pharmacological Interventions: These include behavioral counseling, incentive-based interventions, exercise-based interventions, telephone-based proactive counseling, mobile phone SMS-based interventions, smartphone app-based interventions, web-based interventions, and self-help materials 6. Behavioral counseling is considered one of the most important elements of non-pharmacological interventions.

Combination Therapy

Combination therapy, which involves the use of both pharmacological and non-pharmacological interventions, has been shown to be effective in increasing quit rates 5, 7. This approach can be tailored to individual patients based on their specific needs and preferences.

Patient-Centered Approach

A patient-centered approach is essential in smoking cessation, taking into account the patient's coexisting medical conditions, level of smoking, compliance, previous experience with cessation agents, and the cost of therapy 4, 7. This approach can help clinicians customize the smoking cessation strategy to meet the individual needs of each patient.

Effective Strategies

Effective strategies for smoking cessation include brief advice, specialized counseling, therapeutic education, behavioral support, and first- and second-line pharmacological interventions 7. These strategies can be applied in clinical practice to help smokers quit and reduce the burden of tobacco use.