For Physicians. By Physicians.™
For Physicians. By Physicians.™
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 and state that simply advising patients to quit is insufficient. 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.
Varenicline over other pharmacotherapy (bupropion) or nicotine replacement therapy (nicotine patch)
Varenicline plus a nicotine patch over varenicline alone (conditional recommendation)
Start varenicline even for patients who are not yet ready to quit tobacco
Start varenicline even for patients with comorbid psychiatric disease (substance use disorder, depression/anxiety, schizophrenia, bipolar disorder)
Extended duration (>12 weeks) therapy over standard duration (6-12 weeks) for any cessation aid (varenicline, bupropion or nicotine patch)
Dosing Varenicline
Initial: Days 1 to 3: 0.5 mg once daily | Days 4 to 7: 0.5 mg twice daily
Maintenance (day 8 and later): 1 mg twice daily continued for at least 11 weeks
Note: Dosing should be adjusted for renal function, see references below
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