Appendix VIII: Drugs Used for Smoking Cessation
Updated July 2009
Drugs Used for Smoking Cessation
|Table 1: Drugs Used for Smoking Cessation|
|With the exception of varenicline, the information in this appendix is adapted, with permission, from Rigotti NA. Clinical practice. Treatment of tobacco use and dependence. N Engl J Med 2002;346:506-512. Information regarding varenicline is from City Health Information. New York City Department of Health and Mental Hygiene; December 2007/January 2008. Available at: www.nyc.gov/html/doh/downloads/pdf/chi/chi27-1.pdf
a These products have been approved by the Food and Drug Administration as smoking-cessation aids. The Public Health Service clinical guidelines also recommend them as first-line drugs for smoking cessation.
b The starting dose is 21 mg/d unless the smoker weighs less than 45.5 kg (100 lb) or smokes fewer than 10 cigarettes per day, in which case the starting dose is 14 mg/d. The starting dose should be maintained for 4 weeks, after which the dose should be decreased every week until it is stopped.
c The user should chew the gum slowly until he or she experiences a distinct taste, indicating that nicotine is being released. The user should then place the gum between cheek and gum until the taste disappears to allow the nicotine to be absorbed through oral mucosa. The sequence should be repeated for 30 minutes before the gum is discarded. Acidic beverages (such as coffee and soft drinks) reduce the absorption of nicotine and should be avoided for 30 minutes before and during chewing.
d Tolerance develops to local side effects during the first week of use.
e Treatment should be started 1 week before the quitting date.
f This agent has not been approved by the Food and Drug Administration as a smoking-cessation aid. The Public Health Service clinical guidelines recommend it as a second-line drug for smoking cessation.
g Treatment should be started 10 to 28 days before the quitting date at a dose of 25 mg/d, and the dose should be increased as tolerated.