Pharmacotherpy of Smoking Cessation

ABSTRACT

Cigarette smoking is motivated primarily by a desire for nicotine. Nicotine provides direct effects such as pleasure, stimulation, and stress relief, and it also reverses the unpleasant symptoms of nicotine withdrawal. Most smokers try to quit smoking but find it difficult because of nicotine addiction. Both behavioral counseling and and pharmacotherapy increase the cessation rates, and the effects of these interventions are generally additive. Recent guidelines for smoking cessation recommend that all smokers trying to quit should be offered pharmacotherapy. Two classes of medications have been approved for smoking cessation nicotine replacement medications and bupropion, which was originally marketed as an antidepressant drug. The choice of medications should be individualized-based on the patient's preference,tolerance of adverse effects, and smoking habits.The combination nicotine replacement therapy-a patch plus short acing formulations such as gum or troche is increasingly prescribed to patients with severe addiction. All types of smoking cessation medications, if used properly, double the smoking cessation rate compared with placebo treatment. Some data suggest that the combination and extended duration of pharmacotherapies may offer some advantages, especially in dependent smokers, but these results have been inconclusive. The optimal combinations of medications for tobacco dependence treatment are not yet determined, and few studies have evaluated the effects of more complex combinations.