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    WHAT IF SCREENING IS POSITIVE?

    All patients identified as smokers should be given resources to assist with quitting, e.g. 1-800-QUIT-NOW.1   

     

    Pharmacotherapy

    • Besides counseling, all patients attempting smoking cessation should be offered medications to better quit success and decrease withdrawal symptoms.1  
      • Pregnant women should not routinely use smoking cessation medications.1  More Information
    • The combination of counseling and medications is more effective than either factor alone at increasing smoking cessation rates.1

     

    Nicotine Replacement Therapy

    • Nicotine replacement therapy contains small amounts of nicotine, which helps relieve cravings and reduce symptoms of withdrawal.1
      • Nicotine gum, patch, or lozenge
        • Over-the-counter1
        • 6-month abstinence rate: 19-26%1
      • Nicotine inhaler or nasal spray
        • Prescription1
        • 6-month abstinence rate: 25-27%1

     

    Prescription Non-Nicotine Medications

    • Bupropion (Zyban®)
      • An anti-depressant that works on chemicals in the brain to reduce symptoms of nicotine withdrawal.1,2
      • Contraindications: seizures, heavy alcohol use, cirrhosis, serious head injury, bipolar disorder, anorexia or bulimia, use of sedatives, or recent use of monoamine oxidase inhibitor (MAOI)2
      • Side effects: dry mouth, trouble sleeping, tiredness, agitation, irritability, indigestion, and headaches2
      • Black box warning: may worsen depression and suicide ideation1,2
      • 6-month abstinence rate: 24%1
    •  Varenicline (Chantix®)
      • Blocks the pleasant effects of smoking in the brain and lessens symptoms of nicotine withdrawal.2
      • May increase the risk of cardiovascular events in patients with a history of cardiovascular disease.1,2
      • Side effects: headaches, nausea, vomiting, trouble sleeping, unusual dreams, gas, and changes in taste.2
      • Black box warning: may worsen depression and suicide ideation1,2
      • 6-month abstinence rate: 33%1

     

    Off-Label Smoking Cessation Aids

    • Nortriptyline
      • FDA approved for the treatment of depression.2
      • Side effects: tachycardia, blurry vision, trouble urinating, dry mouth, constipation, weight gain or loss, and orthostasis.2
      • 6-month abstinence rate: 22.5%1
    • Clonidine
      • FDA approved for the treatment of hypertension.2
      • Side effects: constipation, dizziness, drowsiness, dry mouth, and unusual tiredness/weakness.  Rarely, allergic reaction, bradycardia, and very high or very low blood pressure.2
      • 6-month abstinence rate: 25%1
     
     

     
    Resources
    1.  American College of Obstetricians and Gynecologists. (2011). ACOG Committee Opinion 503: Tobacco Use and Women’s Health. Washington, DC:  American College of Obstetricians and Gynecologists.  Available Online: http://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co503.pdf?dmc=1&ts=20141016T2150223316.
    2. Prescription Drugs to Help You Quit Smoking. Retrieved October 5, 2014 from American Cancer Society Website: http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-help-phys-rx-drugs.
    The image on this page is in the public domain and was obtained from Wikimedia Commons.
       
       
      October 2014