title: [Efficacy and safety of medication use for the cessation of tobacco addiction: A review of Clinical Practice Guidelines].
abstract: OBJECTIVE
  To review the efficacy and safety of pharmacotherapy for smoking cessation in the context of clinical practice guidelines (CPG).
  
  
  METHODS
  A systematic review of CPGs was conducted, aimed at adapting recommendations for Colombia following the ADAPTE methodology. Outcomes comprised 6-months or higher smoking cessation rates and intervention safety. CPGs were peer-assessed based on DELBI. Results from aggregative studies included in selected CPGs were obtained.
  
  
  RESULTS
  Pharmacotherapy doubles smoking cessation rates as compared with placebos (rates @25% and up to 27 % when combined with counseling). The highest efficacy was observed for ansyolitic and antidepressive drugs (8.7 % to 19.4 %), and the lowest for nicotine replacement therapy -NRT- (5.2 % to 12.9 %). Nortriptiline shows an efficacy similar to that of bupropion (@10%). With limited exceptions, combined pharmacotherapy for smoking cessation has shown no significant increase in cessation rates.
  
  
  CONCLUSIONS
  NRT, varenicline, bupropion and nortriptiline are effective treatments for smoking cessation. Combination of drugs deserves further clinical evidence and should be restricted to highly dependent smokers or initial therapeutic failure. Cost-effectiveness analyses might help to introduce smoking cessation programs in low and middle income countries.
authors.affiliation: Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia, alejandra.canas@javeriana.edu.co.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Cañas
authors.forename: Luz-H
authors.initials: LH
authors.lastname: Alba
authors.affiliation: Departamento de Medicina Preventiva y Social, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia, lalba@javeriana.edu.co.
authors.forename: Nelci
authors.initials: N
authors.lastname: Becerra
authors.affiliation: Subdirección de Investigaciones, Instituto Nacional de Cancerología, Bogotá, Colombia, rmurillo@cancer.gov.co.
authors.forename: Raúl
authors.initials: R
authors.lastname: Murillo
authors.affiliation: Fundación Neumológica Colombiana, Bogotá, Colombia, npaez@neumologica.org.
authors.forename: Nelson
authors.initials: N
authors.lastname: Páez
authors.affiliation: Departamento de Medicina Preventiva y Social, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia, lalba@javeriana.edu.co.
authors.forename: Catalina
authors.initials: C
authors.lastname: Mosquera
mesh_terms: D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D016642:Bupropion / Q000009:adverse effects / Q000627:therapeutic use; D002637:Chest Pain / Q000139:chemically induced; D003000:Clonidine / Q000009:adverse effects / Q000627:therapeutic use; D003105:Colombia; D003362:Cost-Benefit Analysis; D004333:Drug Administration Routes; D003875:Drug Eruptions / Q000209:etiology; D004359:Drug Therapy, Combination; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D052016:Mucositis / Q000139:chemically induced; D009661:Nortriptyline / Q000009:adverse effects / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced; D016540:Smoking Cessation / Q000191:economics / Q000379:methods; D061485:Tobacco Use Cessation Devices / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome; D000068580:Varenicline / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D016642:Bupropion; D009661:Nortriptyline; D003000:Clonidine; D000068580:Varenicline