Smoking Cessation
Source: Treating Tobacco Use and Dependence- a Quick Reference Guide for
Clinicians. US Public Health Service, October 2000
Effective treatments for tobacco use and dependence now exist and every
patient should be offered at least minimal treatment on every visit to the
clinician.
There is a dose-response relationship between intensity of counseling and
effectiveness of treatment.
Higher cessation rates are achieved when using a combination of
pharmacotherapy and counseling.
Approach To Smoking Cessation
Ask- Does the patient smoke? Advise Quitting - in a clear, strong and personalized manner. |
↓ |
Assess Willingness to make a quit attempt. |
Willing |
Unwilling |
↓ |
↓ |
Assistance - Quit plan
- Practical-counseling
- Social support
(intra/extra-treatment
such as) - Pharmacotherapy
-
Supplementary
reading material ↓
Arrange follow-up |
Motivational Intervention
-
Relevance- to the specific patient
-
Risks:-
acute, long-term and environmental.
-
Rewards:
health, quality of life, protecting others, cosmetic, financial
-
Roadblocks: Fear of withdrawal symptoms, failure, weight gain, lack of
support, depression. enjoyment
-
Repetition: every patient-visit.
|
Pharmacotherapy for Smoking Cessation- first line
|
Pharmacotherapy |
Precautions/
Contraindic. |
Side Effects |
Dosage |
Duration |
|
Buproprion SR
(Zyban) |
History of
seizure
History of
eating disorder |
Insomnia
Dry mouth |
150 mg every
morning for 3 days, then 150mg twice daily(begin treatment 1-2 weeks
pre-quit) |
7-12 weeks
maintenance up to 6 months |
|
Nicotine gum |
|
Mouth soreness
Dyspepsia |
1-24 cigs/day-
2 mg gum (up to 24 pcs/day)
24+cigs/day-4 mg gum (up to 24 pcs/day) |
Up to 12 weeks |
|
Nicotine inhaler |
|
Local
irritation of mouth and throat |
6-16 cartridges
/ day |
Up to 6 months |
|
Nicotine nasal spray |
|
Nasal
irritation |
8-40 doses/day |
3-6 months |
|
Nicotine patch |
|
Local skin
reaction
Insomnia |
21mg/24hrs
14mg/24 hrs
7mg/24hrs
15mg/16hrs |
4 weeks
then 2 weeks then 2 weeks
8 weeks |
|