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Update on pharmacologic and nonpharmacologic therapies for smoking cessation

Walter W. Rosser, MD CCFP FCFP MRCGP
Emeritus Professor in the Department of Family Medicine at Queen’s University

Richard Birtwhistle, MD CCFP FCFP
Director of the Centre for Studies in Primary Care and a Professor in the Department of Family Medicine at Queen’s University

Correspondence to: Jason Schmelzle, Queen’s University, Family Medicine, 220 Bagot St, PO Bag 8888, Kingston, ON K7L 5E9; e-mail jay.schmelzle{at}queensu.ca

OBJECTIVE To review the evidence on the efficacy and safety of pharmacologic and nonpharmacologic therapies for smoking cessation.

QUALITY OF EVIDENCE MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched for randomized controlled trials, meta-analyses, and systematic reviews (level I evidence) pertinent to pharmacologic and nonpharmacologic smoking cessation therapies.

MAIN MESSAGE Pharmacologic smoking cessation aids are recommended for all smokers trying to quit, unless contraindicated. A new pharmacologic smoking cessation aid, varenicline, is now available in Canada. Level I evidence at 1-year follow-up indicates that it is effective for smoking cessation. Adverse effects include nausea, insomnia, and abnormal dreaming. Nausea is mild or moderate and decreases over time. Varenicline is more effective than placebo or bupropion. Counseling also increases the likelihood of achieving cessation.

CONCLUSION Preliminary data indicate that varenicline is more effective than other available pharmacologic smoking cessation aids. Pharmacologic therapy should be combined with nonpharmacologic therapy.