6 responses to “Pharmacotherapy for Tobacco Use Disorder”

  1. In British Columbia patients are entitled to 12 weeks per calendar year. Our team often encourages patients in September in particular; this essentially gives the patient 24 weeks of coverage.

    There is substantial evidence that combining bupropion plus varenicline increases the chance of abstinence, particularly in men and the heavily dependent.

    Rose, JE
    Am J Psychiatry. 2014 Nov 1; 171(11): 1199–1205.
    doi: 10.1176/appi.ajp.2014.13050595

  2. Excellent article, thank you.

    When counseling on smoking cessation it is imporant to discuss the downfalls of quiting that are important to patients. Among those weight gain is a common comment by patients as a fear of quiting. I counsel patients that weight gain is common, but the benefit of quiting smoking is greater than the risk of weight gain. When this side effect is important to patients, this may favour choosing bupropion, if otherwise not contraindicated. The 300mg dose has been shown to not only increase cessation rates, but to also decrease the post cessation weight gain by 50% when compared with placebo.

  3. What if any contraindications to to Varenicline?

  4. I think this is a reasonable approach, assuming the conversation includes a clear recommendation to quit smoking.

  5. Currently I wait until the client is ready to quit smoking varenicline. I may offer prescriptions sooner based on this article.

  6. Interesting, appreciate the article.
    While I agree the literature clearly shows Varenicline is the most effective solo pharmacotherapy, it is associated with adverse events often leading to discontinuation.
    Cytisine is another option, though not covered and doesn’t get the advertising dollars of Pfizer. It was noted in the CMAJ as an option a while ago.
    Though it fails in noninferiority to Varenicline, it should be an option for those who can’t tolerate Varenicline – it does not have the adverse event profile of Varenicline.
    It’s a plant-based alkaloid with selective partial agonist activity at nicotinic acetylcholine receptors (same as Varenicline).
    It has been licensed for use widely in several European and Asian for decades, and was approved as a natural health product by Health Canada a few years ago in 2017.
    RCTs have found Cytisine to be more effective than placebo and nicotine replacement therapy in aiding smoking cessation for at least 6 months.
    Don’t know why the BC Gov. hasn’t made it an option, it’s relatively cheap.
    Here’s interesting reads ….

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