American Thoracic Society: Initiating Pharmacologic Treatment in Tobacco-Dependent Adults
All patients who use tobacco should be provided with treatment to help them quit. The American Thoracic Society (ATS) has released guidance on pharmacotherapy for tobacco cessation. ATS is the first organization to recommend varenicline (Chantix) as first-line therapy for cessation. The guidelines also address combination pharmacotherapy, starting medication for patients who are not yet ready to quit, and treating tobacco users with comorbid psychiatric disease.
ATS Smoking Cessation Recommendations
Varenicline over other pharmacotherapy (bupropion) or nicotine replacement therapy (nicotine patch)
Varenicline superior for achieving long-term abstinence
Generally assessed by patient self-report +/- exhaled carbon monoxide testing
Varenicline associated with fewer serious adverse events (SAEs) vs nicotine patch
No difference in SAEs compared to bupropion
Varenicline plus a nicotine patch over varenicline alone (conditional recommendation)
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