An updated clinical practice guideline released by the U.S. Public Health Service on May 7, 2008, identified new medication treatments that are effective for helping people quit smoking. No matter the level of addiction, anyone attempting to quit should consider trying at least one or more of the effective pharmacotherapies. The goal of cessation pharmacotherapy is to alleviate or diminish the symptoms of withdrawal. The more physically comfortable one is, the more likely the smoker will make a serious quit attempt and succeed in permanently quitting. Currently, the FDA-approved, first-line agents for smoking cessation include five nicotine replacement therapy (NRT) products and two non-nicotine medications. All of these medications were found to be effective first-line medications in the guideline’s meta-analyses. There is no question that the odds of a smoker quitting are increased by using a pharmacological treatment.
In addition, multiple combinations of medications were shown to be effective. For the first time, the 2008 guideline update has assessed the relative effectiveness of cessation medications. These comparisons showed that two forms of pharmacotherapy, varenicline (Chantix) used alone and the combination of a long term nicotine patch plus ad lib (i.e., as needed) nicotine nasal spray or gum, produced significantly higher long term quit rates that did the patch by itself. This is “off label” use but now it is definitively medically sanctioned. (I have been encouraging my own clients to use multiple NRT products for years!)
There are five nicotine replacement therapy (NRT) products on the market the United States. The nicotine gum first appeared in 1984 and the nicotine patch was made available in 1994. Between 1995 and 1996 both became available without prescription. This resulted in the largest increase in smoking cessation since the 1964 Surgeon General’s report on smoking. Two NRT products are still only attainable through prescription. The Nicotrol Nasal Spray appeared in 1996 and the Nicotrol Inhaler in 1998. The final NRT product to materialize, obtainable without prescription, is the nicotine lozenge which has been on the market since 2002.