128. 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)

Should nicotine replacement therapies be avoided in patients with a history of cardiovascular disease?No. The nicotine patch in particular has been demonstrated as safe for cardiovascular patients. See FDA package inserts for more complete information.
May tobacco dependence medications be used long-term (e.g., up to 6 months)?Yes. This approach may be helpful with smokers who report persistent withdrawal symptoms during the course of medications, who have relapsed in the past after stopping medication, or who desire long-term therapy. A minority of individuals who successfully quit smoking use ad libitum NRT medications (gum, nasal spray, inhaler) long-term. The use of these medications for up to 6 months does not present a known health risk and developing dependence on medications is uncommon. Additionally, the FDA has approved the use of bupropion SR, varenicline and some NRT medications for 6 month use.
May medications ever be combined?Yes. Among first-line medications, evidence exists that combining the nicotine patch long-term (> 14 weeks) with either nicotine gum or nicotine nasal spray, the nicotine patch with the nicotine inhaler, or the nicotine patch with bupropion SR, increases long-term abstinence rates relative to placebo treatments. Combining varenicline with NRT agents has been associated with higher rates of side effects (e.g., nausea, headaches).

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Current as of June 2009
Internet Citation: 128. 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/slide128.html