Nicotine replacement therapy |
Prescription |
Standard prescription |
Mode of use |
Initiation: recommended to start on the scheduled cessation date; can be used as pre-cessation therapy on a case-by-case basis Patch: apply to the trunk every morning, in hairless areas that are not exposed to the sun; leave in place for 24 h; no need to remove for bathing; rotate sites Gum: chew until tasting the flavor or feeling a tingling sensation; then leave between the gingiva and the cheek; chew again for 20-30 min Lozenge: slowly move it around in the mouth, without sucking, chewing or swallowing; dissolves in the oral cavity after 20-30 min |
Precautions |
Avoid citrus drinks and food for 15-30 min after using nicotine gum or lozenges. |
Adverse effects |
Patch: erythema and infiltration of the dermis at the site of application, sialorrhea, nausea, vomiting, diarrhea, and insomnia Gum: gingival lesions, sialorrhea, unpleasant taste, dental softening, nausea, vomiting, dyspepsia, hiccups, and pain in the TMJ Lozenges: hiccups, sialorrhea, unpleasant taste, and dyspepsia |
Contraindications |
In the presence of cerebrovascular disease or cardiovascular disease that is severe or acute (< 15 days), discuss with the specialist and assess the risk-benefit ratio. Avoid the use of nicotine gum or lozenges in patients with active peptic ulcer or TMJ pain. In patients who are pregnant or breastfeeding, weigh the risk-benefit ratio of a dose lower than that of smoking and opt for gum or lozenges over the patch. |
Efficacy |
Relative risk of success = 2.60 (95% CI: 1.29-5.24) |
Combinations |
Patch used in combination with nicotine lozenges or gum Addition of bupropion or varenicline in cases that are more difficult |
Bupropion |
Prescription |
Restricted prescription, in duplicate |
Mode of use |
Start 7 days before the scheduled cessation date. Take the second tablet in the afternoon, at least 8 h after the first. |
Precautions |
If possible, avoid taking the 2nd dose after 5:00 p.m., to reduce the risk of insomnia. Patients with gastritis should use an antacid and take bupropion with food. Patients with uncontrolled hypertension should not take bupropion. |
Adverse effects |
Reduced reflexes (poor performance on tasks that require motor skills), dry mouth, insomnia, dizziness, headache, agitation, anxiety, tremors |
Contraindications and drug interactions |
Numerous drug interactions Relative: harmful use of alcohol; and the use of carbamazepine, barbiturates, phenytoin, antipsychotics, antidepressants, cimetidine, theophylline, systemic corticosteroids, oral hypoglycemic agents, and insulin Absolute: epilepsy and seizures (including febrile seizures), recent alcohol withdrawal, cerebrovascular disease, bulimia, anorexia nervosa, panic attacks, use of MAO inhibitors in the last 14 days, < 16 years of age, pregnancy, and breastfeeding |
Efficacy |
Relative risk of success = 2.03 (95% CI: 1.26-3.28) |
Combinations |
Addition of nicotine replacement therapy or varenicline in cases that are more difficult |
Varenicline |
Prescription |
Standard prescription |
Mode of use |
Start 7 days before the scheduled cessation date 0.5-mg tablets only for the 1st week, then 1-mg tablets twice daily for 11 weeks |
Precautions |
The bioavailability is not affected by eating or by the schedule of administration; it can be taken after meals. |
Adverse effects |
Most common: nausea (in 33%, rarely requiring discontinuation); and vivid dreaming Some patients report dizziness, dry mouth, drowsiness, and flatulence. It can be associated with depressive mood, suicidal ideation, and lack of control of psychiatric disorders, although such symptoms can also occur due to withdrawal syndrome. |
Contraindications and drug interactions |
Few drug interactions Use with caution in smokers with severe psychiatric disorders (psychotic outbreak, suicidal ideation/attempt, etc.): discuss with the psychiatrist. |
Efficacy |
Relative risk of success = 3.35 (95% CI: 1.89-5.92) |
Combinations |
Addition of nicotine replacement therapy or bupropion in cases that are more difficult |