Cessation counseling and medication are effective when used by themselves for treating tobacco dependence. However, the combination of counseling and medication is more effective than either alone.
The U.S. Food and Drug Administration (FDA) has approved seven medications that can help your patients quit for good:
- Five nicotine replacement therapies (NRT):
- transdermal patch*
- nasal spray†
- oral inhaler†
- Two non-nicotine medications:
- bupropion (Zyban, Wellbutrin)†
- varenicline (Chantix)†
* available over-the-counter (OTC) and covered by Medicaid and some health insurance plans with prescription
Not all smokers can quit with single-drug therapy. Evidence exists that combination pharmacotherapy increases long-term abstinence rates relative to placebo treatments. Note: Varenicline should not be combined with any other smoking cessation medication.
- Combination long-acting + short-acting NRT:
- provides a stable baseline nicotine level from the sustained release transdermal patch with immediate release nicotine gum, lozenge, nasal spray or oral inhaler;
- may provide a therapeutic advantage by increasing nicotine concentrations to help prevent the onset of severe withdrawal symptoms;
- may be particularly effective in suppressing tobacco withdrawal symptoms and especially useful for highly dependent smokers or those with a history of severe withdrawal.
- Bupropion + long-acting transdermal patch:
- Monitored treatment with bupropion and an NRT patch is more effective in increasing long-term cessation abstinence than either medication alone.
Medicaid and FDA changes make it easier to prescribe safe and effective smoking cessation regimens for your patients:
- removed the two-course annual limit for smoking cessation medications, including combination pharmacotherapy; and
- removed prior authorization for prescribing cessation medication (except for brand-name products when generics are available).
- determined there are no significant safety concerns with prescribing combination nicotine replacement therapy (NRT) or using NRT even if a person is still smoking;
- determined it is safe in most cases to use NRT longer than the 8 to 12 weeks that label directions may state; and
- evaluated varenicline and bupropion and found the benefits outweigh the risks of using them for most people. As a result, FDA approved the removal of the boxed warning about potential neuropsychiatric side effects from the drug labels of both Chantix and Zyban when used for smoking cessation.
For More Information
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guidelines. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008