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Tobacco 101: A Guide to Working with Nicotine Addicted Patients

Course Number: 534

Pharmacological Agents

Bupropion HCL (Zyban)

This drug was approved for medical use in 1989. It inhibits the neuronal uptake of norepinephrine and dopamine and is a nicotinic antagonist. It is used as an antidepressant and smoking cessation aid. In a 2013 Cochrane review of medications used for smoking cessation, Bupropion helped about 80% more people quit than placebo.49 This drug is contraindicated for epileptics/people with lower seizure thresholds or people taking MAO inhibitors. It should also be used cautiously in patients with liver damage, severe kidney disease or severe hypertension, and in pediatric patients, adolescents, and young adults due to potential suicide ideation.49 The most common side effects are headache and transient insomnia. A thorough review of this drug must be done before prescribing it by any healthcare provider.

Varenicline (Chantix, Champix)

Varenicline was developed by modifying the structure of cytosine and was approved for use in 2006. This drug is used to treat nicotine addiction. It is a nicotinic receptor site partial agonist and can reduce cravings and decrease the pleasurable effects of tobacco products. In a 2013 Cochrane review,49 Varenicline more than doubled the chances of quitting compared to placebo. It has not been tested for those under 18, or pregnant women, and is not recommended for this group. The most common side effect is nausea. Less common side effects include headache, difficulty sleeping and nightmares. A 2014 systematic review did not find any increased suicide risk.51 Multiple recent reviews also found no increase in overall or serious cardiovascular events.52 Again, a thorough review of this drug must be done before it is prescribed.51-53

Pharmacological Agents - Figure 1

Varenicline (Chantix, Champix)