[Show abstract][Hide abstract] ABSTRACT: Strategies for assisting smoking cessation include behavioural counselling to enhance motivation and to support attempts to quit and pharmacological intervention to reduce nicotine reinforcement and withdrawal from nicotine. Three drugs are currently used as first-line pharmacotherapy for smoking cessation: nicotine replacement therapy, bupropion, and varenicline. Compared to placebo, the drug effect varies from 2.27 (95% CI 2.02-2.55) for varenicline, to 1.69 (95% CI 1.53-1.85) for bupropion, and to 1.60 (95% CI 1.53-1.68) for any form of nicotine replacement therapy. Despite some controversy regarding the safety of bupropion and varenicline, regulatory agencies consider these drugs as having a favourable benefit/risk profile. However, given the high rate of psychiatric comorbidity in dependent smokers, practitioners should closely monitor patients for neuropsychiatric symptoms. Second-line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments and issues related to smoking cessation in special populations: persons with psychiatric comorbidity and pregnant and adolescent smokers.
Full-text · Article · Mar 2013 · British Journal of Clinical Pharmacology
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