Pharmacological Agents

Bupropion HCL (Zyban)

This drug was approved for medical use in 1989. It inhibits the neuronal uptake of norepinephrine and dopamine and is a nicotinic antagonist. It is used as an antidepressant and smoking cessation aid. “Smoking cessation may increase from 11% in control groups to 19% in those using bupropion SR”.⁵⁰ This drug is contraindicated for epileptics/people with lower seizure thresholds or people taking MAO inhibitors. It should also be used cautiously in patients with liver damage, severe kidney disease or severe hypertension, and in pediatric patients, adolescents, and young adults due to potential suicide ideation.⁵⁰ The most common side effects are headache and transient insomnia. A thorough review of this drug must be done before prescribing it by any healthcare provider.

Varenicline (Chantix, Champix)

Varenicline was developed by modifying the structure of cytosine and was approved for use in 2006. This drug is used to treat nicotine addiction. It is a nicotinic receptor site partial agonist and can reduce cravings and decrease the pleasurable effects of tobacco products. Smoking cessation rates have been shown to increase from 12% in control groups to 28% in those using Varenicline. It has not been tested for those under 18, or pregnant women, and is not recommended for this group. The most common side effect is nausea. Less common side effects include headache, difficulty sleeping and nightmares. A 2014 systematic review did not find any increased suicide risk. Multiple recent reviews also found no increase in overall or serious cardiovascular events. Again, a thorough review of this drug must be done before it is prescribed.^50-52

Varenicline (Chantix, Champix)

Behavioral Interventions

Over the years it has been shown that behavioral interventions such as in-person individual or group counseling, telephone counseling, and self-help with materials can be effective. In addition, with the increase in internet access via cell phones, new cessation apps are now available for adults as well as kids that are addicted to nicotine. According to the National Center for Biotechnology Information, these interventions may increase rates of smoking cessation from a baseline of 5% to 11% in control groups to 7% to 13% in intervention groups. Both minor and intensive in-person interventions increase the proportion of persons who successfully quit smoking and remain abstinent. However, more or longer sessions improve cessation rates. According to the Public Health Service guidelines, individuals should undergo at least 4 in-person counseling sessions. Interventions delivered by various types of providers, including physicians, nurses, psychologists, social workers, and cessation counselors, can be effective. Effective telephone counseling interventions should provide at least 3 telephone calls and can be provided by trained professional counselors or health care providers. Self-help material shown to be effective is the one that is tailored to the individual patient and is primarily print based.⁵⁰

In addition, with the increase in internet access via cell phones, new cessation apps are now available for adults as well as kids that are addicted to nicotine. The quitStart App is a free phone app, a product of Smokefree.gov, a smoking cessation resource created by the Tobacco Control Research Branch at the National Cancer Institute in collaboration with the U.S. Food and Drug Administration and input from tobacco control professionals, smoking cessation experts, and ex-smokers.⁵² The “This is Quitting app has been created by the “Truth Initiative” and has helped over 500,000 youth and young adults quit vaping.⁵³