Smoking Cessation Therapies

Smoking cessation pharmacotherapy should be used with a comprehensive behavioral smoking cessation program. Nicotine replacement therapy used in conjunction with a frequent, intensive, high-quality smoking cessation program is more successful than either used alone. Every smoker should be offered smoking cessation therapy at every office visit. Make first follow-up contact preferably during the first week of anticipated quit date, second contact within the first month, and additional follow-up as needed. Intensive interventions are more effective.

Patients must stop smoking before starting a nicotine replacement regimen. Concomitant drugs may need adjustment in dose when smoking is stopped.

Pregnant or breastfeeding smokers should first be encouraged to attempt to quit smoking without pharmacologic therapy. They should be offered intensive counseling treatment. Nicotine replacement should be used during pregnancy only if the increased likelihood of quitting smoking (and its benefits) outweighs the risks of nicotine replacement therapy.

Pediatric and adolescent patients should be provided with counseling interventions to aid with smoking cessation. Counseling has been shown to be effective in treatment of adolescent smokers. Nicotine replacement therapy and bupropion SR are not recommended as a component of pediatric tobacco use interventions. Although shown to be safe in adolescents, these medications have shown little evidence to be effective in promoting long-term smoking abstinence. Small amounts of nicotine may be toxic to children and animals; these products should be stored in a safe place away from children and pets (including used patches).

Local skin reactions may occur with nicotine patches. Treatment with a mild steroid cream may be helpful.

Concerns about weight gain should be addressed by informing the patient about its likelihood and preparing for its occurrence. Clinicians should neither deny the likelihood of weight gain nor minimize its significance to the patient. During the quit attempt, patients should be offered help addressing weight gain by encouraging to adopt a healthy lifestyle (eg, diet consisting of fruits and vegetables, limit alcohol consumption, exercise). For smokers with great concerns about weight gain, bupropion SR or nicotine replacement therapy (esp. nicotine gum and lozenge) is recommended, which have been shown to delay weight gain after quitting.