Tobacco Use, Part 2
While discussing the risks associated with smoking, the pharmacist decides to take a few minutes to explain to CB some of the pharmacologic treatment options available for smoking cessation. The pharmacist informs her that pharmacologic therapy is useful in all patients who smoke more than 10 cigarettes per day who are not pregnant or who have other confounding medical conditions. The pharmacist recommends that she talk to her doctor before making any decision, but he wants to make sure that she has all the available information to help her choose a therapy.
The pharmacist starts by informing her of the various nicotine replacement therapy options, including the patch, gum, lozenge, inhaler, and nasal spray. He explains that these agents work to replace the nicotine lost when smoking is stopped, thereby reducing the intensity of withdrawal symptoms. CB jokes that she would need more than 1 of those options. The pharmacist explains that evidence does support the combining of nicotine replacement therapies, such as wearing a patch and chewing a piece of nicotine gum during a bad craving.
CB asks, “Can’t I just pop a pill? That would be easier than some of these other options.” The pharmacist tells her that a product called Zyban (bupropion) also is marketed as an antidepressant and may work to treat depression and nicotine addiction simultaneously. This drug should be avoided in patients with a history of seizures, because it will increase the risk that a patient will have a seizure. Finally, the pharmacist tells her about Chantix (varenicline), which stimulates the nicotine receptor and has been found to be effective in smoking cessation.
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