Table 6.

Pharmacologic agents for smoking cessation [29,30,37,38].

Generic Name	Brand Name(s)	Mechanism of Action	Common Adverse Effects	Dose
Nicotine gum	Nicorette, Equate, Top Care, others	Partially replace the nicotine formally obtained from tobacco, which aids smoking cessation by reducing the severity of withdrawal symptoms and cravings	Jaw pain, mouth, soreness, dyspepsia, hiccups	The 2-mg gum is for patients smoking less than 25 cigarettes/day; the 4 mg gum for patients smoking 25 or more cigarettes/day. Use at least 1 piece every 1 to 2 h for the 1st 6 weeks; the gum should be used for up to 12 weeks with no more than 24 pieces to be used per day
Nicotine lozenge	Sunmark, Top Care, others	See above	Mouth and throat, hiccups	2 mg lozenge for patients who smoke their 1st cigarette more than 30 min after waking, and the 4 mg lozenge for patients who smoke their 1st cigarette within 30 min of waking. Generally, smokers should use at least 9 lozenges/day in the first 6 weeks; the lozenge should be used for up to 12 weeks, with no more than 20 lozenges/day
Nicotine patch	Nicoderm CQ, Equate, others	See above	Mild skin irritation at placement site	For those who smoke more than 10 cigarettes/day: 21 mg patch for 6–8 weeks, decrease 14 mg for 2–4 weeks, then 7 mg for 2–4 weeks. For less than 10 cigarettes/day: 14 mg for 6 weeks, decrease to 7 mg for 2–4 weeks.
Nicotine inhaler	Nicotrol	See above	Mouth and throat irritation, cough	A dose from consists 1 inhalation. Recommended dosage is 6–16 cartridges/day. Recommended duration of therapy is up to 6 months.
Nicotine nasal spray	Nicotrol NS	See above	Runny nose, throat and nasal irritation, cough	Spray 1–2 doses/h, increasing as needed for symptom relief. Minimum recommended treatment is 8 doses/day, with a maximum of 40 doses/day (5 doses/h). Each bottle contains approximately 100 doses. Recommended duration of therapy is 3–6 months
Bupropion SR	Zyban, Wellbutrin SR	Inhibitor of dopamine and norepinephrine reuptake, but its mechanism of action in smoking cessation is not well understood	Insomnia, dry mouth, headache, tremors, nausea, anxiety	Begin treatment 1–2 weeks. quit date. Begin with a dose of 150 mg every morning for 3 days, then 150 mg twice daily. Dosage should not exceed 300 mg/day. Dosing at 150 mg twice daily should continue for 7–12 weeks. For long-term therapy, consider use for up to 6 months post-quit
Varenicline	Chantix	Partial agonist specific for the neuronal nicotinic acetylcholine receptor subtype α4β2.	Nausea, insomnia, abnormal dreaming, headache	Start 1 week before the quit date at 0.5 mg once daily for 3 days, then 0.5 mg twice daily for 4 days, then 1 mg twice daily for 3 months approved for up to 6 months. Note: Patient should be instructed to quit smoking on day 8, when dosage is increased to 1 mg twice daily