126. Treatment Recommendations: Medications (Continued)

Treating Tobacco Use and Dependence: 2008 Update

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

What medications should a clinician use with a patient who is highly nicotine dependent? The higher dose preparations of nicotine gum, patch, and lozenge have been shown to be effective in highly dependent smokers. Also, there is evidence that combination NRT therapy may be particularly effective in suppressing tobacco withdrawal symptoms. Thus it may be that NRT combinations are especially helpful to highly dependent smokers or those with a history of severe withdrawal.
Is gender a consideration in selecting a medication? There is evidence that NRT can be effective with both sexes; however, evidence is mixed as to whether NRT is less effective in women than men. This may encourage the clinician to consider use of another type of medication with women such as bupropion SR or varenicline.
Are cessation medications appropriate for light smokers (i.e., <10 cigarettes/day)? As noted above, cessation medications have not been shown to be beneficial to light smokers. However, if NRT is used with light smokers, clinicians may consider reducing the dose of the medication. No adjustments are necessary when using bupropion SR or varenicline.

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Page last reviewed October 2014
Page originally created September 2012
Internet Citation: 126. Treatment Recommendations: Medications (Continued). Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/presentations/2008update-full/slide126.html