127. Treatment Recommendations: Medications (Continued)

Treating Tobacco Use and Dependence: 2008 Update

Text version of slide presentation.

Treatment Recommendations: Medications (Continued)

Clinical guidelines for prescribing medication for treating tobacco use and dependence (continued)

When should second-line agents be used for treating tobacco dependence?Consider prescribing second-line agents (clonidine and nortriptyline) for patients unable to use first-line medications because of contraindications or for patients for whom the group of first-line medications has not been helpful. Assess patients for the specific contraindications, precautions, other concerns, and side effects of the second-line agents. Please refer to FDA package inserts for this information and to the individual drug tables in this document.
Which medications should be considered with patients particularly concerned about weight gain?Data show that bupropion SR and nicotine replacement therapies, in particular 4 mg nicotine gum and 4 mg nicotine lozenge, delay, but do not prevent, weight gain.
Are there medications that should be especially considered in patients with a past history of depression?Bupropion SR and nortriptyline appear to be effective with this population but nicotine replacement medications also appear to help individuals with a past history of depression.

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Page last reviewed June 2009
Internet Citation: 127. Treatment Recommendations: Medications (Continued): Treating Tobacco Use and Dependence: 2008 Update. June 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/presentations/2008update-full/slide127.html