Continuous abstinence (abstinence from quit date) was also higher for the bupropion groups compared with placebo (bupropion 18%, placebo 6%; ARR=0.12; NNT=8; P<.001). Adding nicotine replacement to bupropion therapy increased 1-year smoking cessation rates by 5% over bupropion alone but was not statistically significant.
A Cochrane review assessing the efficacy of antidepressants for smoking cessation showed that, when used as monotherapy, bupropion (31 trials; OR=1.94; 95% CI, 1.72-2.19) and nortriptyline (4 trials; OR=2.34; 95% CI, 1.61-3.41) both doubled the odds of smoking cessation.6
Another option: Varenicline
Varenicline, a partial agonist at the α4β2 nicotinic acetylcholine receptor, aids smoking cessation by relieving nicotine withdrawal symptoms. A Cochrane meta-analysis concluded that varenicline resulted in significantly greater continuous abstinence at 12 months than placebo (OR=3.22; 95% CI, 2.43-4.27; NNT=8; 95% CI, 5-11).7
Recommendations
The US Preventive Service Task Force (USPSTF) strongly recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions as needed.8 The USPSTF’s Clinical Practice Guideline for treating tobacco dependence recommends following a 5-step (5 A’s) intervention for smoking cessation in patients willing to quit.1
- Ask the patient about smoking status at every visit.
- Advise the patient to stop smoking.
- Assess the patient’s willingness to quit.
- Assist the patient by setting a date to quit smoking, providing self-help materials, and recommending the use of pharmacologic agents.
- Arrange for follow-up visits.