128. Treatment Recommendations: Medications (Continued)
Treating Tobacco Use and Dependence: 2008 Update
Text version of slide presentation.
Clinical guidelines for prescribing medication for treating tobacco use and dependence (continued)
Should nicotine replacement therapies be avoided in patients with a history of cardiovascular disease? | No. The nicotine patch in particular has been demonstrated as safe for cardiovascular patients. See FDA package inserts for more complete information. |
May tobacco dependence medications be used long-term (e.g., up to 6 months)? | Yes. This approach may be helpful with smokers who report persistent withdrawal symptoms during the course of medications, who have relapsed in the past after stopping medication, or who desire long-term therapy. A minority of individuals who successfully quit smoking use ad libitum NRT medications (gum, nasal spray, inhaler) long-term. The use of these medications for up to 6 months does not present a known health risk and developing dependence on medications is uncommon. Additionally, the FDA has approved the use of bupropion SR, varenicline and some NRT medications for 6 month use. |
May medications ever be combined? | Yes. Among first-line medications, evidence exists that combining the nicotine patch long-term (> 14 weeks) with either nicotine gum or nicotine nasal spray, the nicotine patch with the nicotine inhaler, or the nicotine patch with bupropion SR, increases long-term abstinence rates relative to placebo treatments. Combining varenicline with NRT agents has been associated with higher rates of side effects (e.g., nausea, headaches). |