Update on pharmacologic and nonpharmacologic therapies for smoking cessation.
OBJECTIVE
To review the evidence on the efficacy and safety of pharmacologic and nonpharmacologic therapies for smoking cessation.


METHODS
MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched for randomized controlled trials, meta-analyses, and systematic reviews (level I evidence) pertinent to pharmacologic and nonpharmacologic smoking cessation therapies.


RESULTS
Pharmacologic smoking cessation aids are recommended for all smokers trying to quit, unless contraindicated. A new pharmacologic smoking cessation aid, varenicline, is now available in Canada. Level I evidence at 1-year follow-up indicates that it is effective for smoking cessation. Adverse effects include nausea, insomnia, and abnormal dreaming. Nausea is mild or moderate and decreases over time. Varenicline is more effective than placebo or bupropion. Counseling also increases the likelihood of achieving cessation.


CONCLUSIONS
Preliminary data indicate that varenicline is more effective than other available pharmacologic smoking cessation aids. Pharmacologic therapy should be combined with nonpharmacologic therapy.
Schmelzle
Jason
J
Queen's University, Family Medicine, 220 Bagot St, PO Bag 8888, Kingston, ON K7L 5E9. jay.schmelzle@queensu.ca
Rosser
Walter W
WW
Birtwhistle
Richard
R
D002170:Canada; D006801:Humans; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D012907:Smoking / Q000188:drug therapy* / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D014029:Tobacco Use Disorder / Q000188:drug therapy*
D018722:Nicotinic Agonists