Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice
Open accessAbstract
Strategies for assisting smoking cessation include behavioural counselling to enhance motivation and to support attempts to quit and pharmacological intervention to reduce nicotine reinforcement and withdrawal from nicotine. Three drugs are currently used as first line pharmacotherapy for smoking cessation, nicotine replacement therapy, bupropion and varenicline. Compared with placebo, the drug effect varies from 2.27 (95% CI 2.02, 2.55) for varenicline, 1.69 (95% CI 1.53, 1.85) for bupropion and 1.60 (95% CI 1.53, 1.68) for any form of nicotine replacement therapy. Despite some controversy regarding the safety of bupropion and varenicline, regulatory agencies consider these drugs as having a favourable benefit/risk profile. However, given the high rate of psychiatric comorbidity in dependent smokers, practitioners should closely monitor patients for neuropsychiatric symptoms. Second‐line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments and issues related to smoking cessation in special populations such as persons with psychiatric comorbidity and pregnant and adolescent smokers.
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Some smoking cessation pharmacotherapies may increase suicide risk, although not all research supports this.
“Some of the pharmacotherapies may carry an increased risk of suicide,20 although not all of the research supports this.21”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [20]
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- Authors
- Aubin, H., Luquiens, A., & Berlin, I.
- Affiliations
- Inserm (FR)
- Pitié-Salpêtrière Hospital (FR)
- Corresponding author
- Aubin, Henri‐Jean
- Venue
- British Journal of Clinical Pharmacology
- Publisher
- Wiley
- Published
- 2014-01-22
- Volume
- 77
- Issue
- 2
- Pages
- 324-336
- ISSN
- 0306-5251 (ISSN-L)
- 1365-2125
- PMC
- PMC4014023
- OpenAlex
- W1778717419
- Cited by
- 138
- References
- 167
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 10 · 2023: 12 · 2022: 16 · 2021: 8 · 2020: 12 · 2019: 4 · 2018: 11 · 2017: 17 · 2016: 13 · 2015: 8 · 2014: 6 · 2013: 4
- FWCI
- 1.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Clinical Pharmacology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
- Keywords
- smoking cessation, nicotine replacement therapy, bupropion, varenicline, nicotine dependence, nicotine withdrawal, nicotine reinforcement, nortriptyline, clonidine, psychiatric comorbidity, neuropsychiatric adverse effects, pregnant smokers, adolescent smokers, drug safety
- MeSH terms
- Varenicline, Adolescent, Benzazepines, Counseling, Female, Humans, Molecular Sequence Data, Pregnancy, Quinoxalines, Tobacco Use Disorder, Drug Design, Smoking Cessation, Bupropion, Tobacco Use Cessation Devices
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