127. 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)

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 October 2014
Page originally created September 2012
Internet Citation: 127. 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/slide127.html