Table 8.

Highlights of Recommended Behavioral and Pharmacotherapy Tobacco Treatment Modalities for Prescribed^*

Timing of Behavioral Interventions†
<3 min of tobacco status assessment with cessation counseling at each clinic encounter	>3-10 min of tobacco status assessment with cessation counseling at each clinic encounter		>10 min of tobacco status assessment with cessation counseling at each clinic encounter
Treatment	Dosing‡		Precautions
NRT*
Patch	21 mg, 14 mg, or 7 mg	Starting dose: 21 mg for ≥10 CPD; 14 mg for <10 CPD	Local irritation possible; avoid with skin disorders; may remove for sleep if needed
Gum	2 mg or 4 mg	Starting dose: 4 mg if first tobacco use is ≤30 min after waking; 2 mg if first tobacco use is >30 min after waking; maximum of 20 lozenges or 24 pieces of gum/d. Chew and park gum*	Hiccups/dyspepsia possible; avoid food or beverages 15 min before and after use
Lozenge	2 mg or 4 mg
Nasal spray	10 mg/mL	Starting dose: 1-2 doses/h (1 dose=1 spray each nostril); maximum of 40 doses/d	Local irritation possible; avoid with nasal or reactive airway disorders
Oral inhaler	10-mg cartridge	Starting dose: Puff for 20 min/cartridge every 1-2 h; maximum 16 cartridges/d	Cough possible; avoid with reactive airway disorders
Other§
Bupropion (Zyban [GlaxoSmithKline], Wellbutrin SR [GlaxoSmithKline])	150 mg SR	150 mg once daily (am) for 3 d; then 150 mg twice daily; may use in combination with NRTS4.5-21	Avoid with history/risk of seizures, eating disorders, MAO inhibitors, or CYP 2D6 inhibitor
Varenicline (Chantix [Pfizer])	0.5 mg or 1 mg	0.5 mg once daily (am) for 3 d; then 0.5 mg twice daily for 4 d; then 1 mg twice daily (use start pack followed by continuation pack) for 3-6 mo	Nausea common; take with food. Renal dosing required. Very limited drug interactions; near-exclusive renal clearance.

^*CPD can guide dosing. 1 CPD is ≈1-2 mg of nicotine. Note: Use caution with all NRT products for patients with recent (≤2 wk) MI, serious arrhythmia, or angina; patients who are pregnant or breastfeeding; and adolescents.

^†Timing of assessment relates to ICD-10 coding.

^‡Dose and duration can be titrated on the basis of response.^S4.5-21

^§The FDA has issued a removal of black box warnings about neuropsychiatric events.^{S4.5-20,S4.5-21}

am indicates morning; CPD, cigarettes smoked per day; FDA, US Food and Drug Administration; ICD-10, International Classification of Diseases, Tenth Revision; MAO, monoamine oxidase; NRT, nicotine replacement; and SR, sustained release.