From the Guidelines
Smoking cessation treatment should include a combination of behavioral support and medication therapy, with the most effective approach being a combination of pharmacologic therapy and behavior therapy, as recommended by the US Preventive Services Task Force 1.
Key Components of Smoking Cessation Treatment
- First-line medications include nicotine replacement therapy (NRT), varenicline (Chantix), and bupropion (Zyban) 1.
- NRT comes in various forms: patches (21mg, 14mg, or 7mg for 24-hour use), gum (2mg or 4mg), lozenges (2mg or 4mg), nasal spray (1-2 doses per hour), and inhalers (6-16 cartridges daily) 1.
- Varenicline is started at 0.5mg once daily for 3 days, then 0.5mg twice daily for 4 days, followed by 1mg twice daily for 12-24 weeks 1.
- Bupropion SR begins at 150mg daily for 3 days, then 150mg twice daily for 7-12 weeks 1.
- Combining NRT products (like patch plus gum) or using NRT with bupropion can increase success rates 1.
- Behavioral support should include setting a quit date, identifying triggers, developing coping strategies, and regular follow-up 1.
Importance of Combination Therapy
- Combining behavioral and pharmacotherapy interventions has been shown to increase tobacco smoking cessation rates compared with either usual care/brief cessation interventions alone or pharmacotherapy alone 1.
- The largest effect was found in interventions that provided 8 or more sessions, although the difference in effect among the number of sessions was not significant 1.
Duration of Treatment
- Treatment should continue for at least 8-12 weeks, with longer durations showing better outcomes for maintaining abstinence 1.
Patient-Centered Approach
- Smoking cessation interventions should be offered and continued throughout the oncology care continuum, including during end-of-life care, with emphasis on patient preferences and values 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION 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. (2.1) INDICATIONS AND USAGE NICOTROL Inhaler is indicated as an aid to smoking cessation for the relief of nicotine withdrawal symptoms. NICOTROL Inhaler therapy is recommended for use as part of a comprehensive behavioral smoking cessation program.
Smoking Cessation Treatment Options:
- Varenicline (PO) can be used for smoking cessation, with a recommended dosage of 0.5 mg once daily on days 1 to 3 and 0.5 mg twice daily on days 4 to 7, followed by 1 mg twice daily for a total of 12 weeks 2.
- Nicotine (INH) is also indicated as an aid to smoking cessation for the relief of nicotine withdrawal symptoms, and should be used as part of a comprehensive behavioral smoking cessation program 3. Key Considerations:
- Varenicline may have neuropsychiatric adverse events, and patients should be observed for such symptoms and instructed to discontinue the medication if they experience any adverse events 2.
- A gradual approach to quitting smoking with varenicline may be considered for patients who are not able or willing to quit abruptly 2.
From the Research
Smoking Cessation Treatment Options
- Smoking cessation is a complex process that requires a combination of behavioral and pharmacological interventions 4, 5, 6.
- The most effective approach for treating tobacco dependence is a combination of behavioral and pharmacological therapies 5, 7.
- Behavioral interventions, such as counseling and support groups, can increase smoking cessation rates by 7-16% 4.
- Pharmacological treatments, such as nicotine replacement therapy (NRT), bupropion, and varenicline, can increase smoking cessation rates by up to 24% when combined with behavioral support 4, 8, 7.
Pharmacological Treatment Options
- NRT is a widely used and effective treatment for smoking cessation, with a success rate of 1.5-2-fold after 12 months 8.
- Bupropion is an alternative to NRT and has been shown to be effective for smoking cessation, with a success rate similar to NRT 8.
- Varenicline is a newer treatment option that has been shown to be at least as effective as bupropion for smoking cessation 8.
- Combination pharmacotherapy, such as combining NRT with bupropion or varenicline, may be beneficial for highly nicotine-dependent smokers or those who have failed with monotherapy 4, 7.
Behavioral Intervention Options
- Counseling and support groups can provide smokers with the motivation and skills needed to quit smoking 4, 5, 7.
- Behavioral interventions can be provided by specialists in cessation counseling or by usual care providers 7.
- The intensity and duration of behavioral interventions can vary, but there is evidence that more intensive interventions may be associated with larger treatment effects 7.
Current Standard of Care
- The current standard of care for smoking cessation is a combined psychological and pharmacological treatment approach 6.
- This approach recognizes that smoking cessation is a complex process that requires a comprehensive treatment plan that addresses both the physical and psychological aspects of addiction 4, 5, 6.