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Smoking causes approximately 430,000 smoking deaths each year, accounting for 19.5% of all deaths. Smoking cessation treatments should be offered to every patient who smokes.
Behavioral counseling, either group or individual, can raise the rate of abstinence to 20%-25%. The primary goals are to change the mental processes of smoking, reinforce the benefits of nonsmoking, and teach skills to help the smoker avoid
Smoking cessation pharmacotherapy
The symptoms of withdrawal begin within a few hours and peak at 24-48 hours after quitting. Anxiety, hostility and anger
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Treatments for smoking cessation |
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Drug |
Dosage |
Comments |
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Nicotine gum (Nicorette) |
2- or 4-mg piece/30 min |
Available OTC; poor compliance |
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Nicotine patch (Habitrol, Nicoderm CQ) |
1 patch/d for 6-12 wk, then taper for 4 wk |
Available OTC; local skin reactions |
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Nicotine nasal spray (Nicotrol NS) |
1-2 doses/h for 6-8 wk |
Rapid nicotine delivery; nasal irritation initially |
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Nicotine inhaler (Nicotrol Inhaler) |
6-16 cartridges/d for 12 wk |
Mimics smoking behavior; provides low doses of nicotine |
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Bupropion (Zyban) |
150 mg/day for 3 d, then titrate to 300 mg |
Treatment initiated 1 wk before quit day; contraindicated with seizures, anorexia, heavy alcohol use |
Nicotine polacrilex (Nicorette) is available OTC. The patient should use1-2 pieces per hour. A 2-mg dose is recommended for those who smoke fewer than 25 cigarettes per day, and 4 mg for heavier smokers. It is used for
Transdermal nicotine (Habitrol, Nicoderm, Nicotrol) doubles abstinence rates compared with placebo, The patch is
Nicotine nasal spray (Nicotrol NS) is available by prescription and is a good choice for patients who have not been able to quit with the gum or patch or for heavy smokers. It delivers a high level of nicotine, similar to smoking. Nicotine nasal
Nicotine inhaler (Nicotrol Inhaler) delivers nicotine orally via inhalation from a plastic tube. It is available by prescription and has a success rate of 28%, similar to nicotine gum. The inhaler has the advantage of avoiding some of the
Bupropion (Zyban) is appropriate for patients who have been unsuccessful using nicotine replacement. Bupropion reduces withdrawal symptoms and can be used in conjunction with nicotine replacement therapy. Cessation rates are