So what do you like to use to treat smoking cessation?

[Blitz2006]

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I was reading up on Varenicline, and according to some reviews, pretty good.

True?

Or do you guys prefer NRT/Wellbutrin?

According to this cochrane review, combo NRT and varenicline are the best options.

http://www.cochrane.org/CD009329/TOBACCO_medications-help-people-stop-smoking-overview-reviews

I'm just a bit worried about varenicline side effects....or should I not be?

 

[HarryMTieboutMD]

I was reading up on Varenicline, and according to some reviews, pretty good.

True?

Or do you guys prefer NRT/Wellbutrin?

According to this cochrane review, combo NRT and varenicline are the best options.

http://www.cochrane.org/CD009329/TOBACCO_medications-help-people-stop-smoking-overview-reviews

I'm just a bit worried about varenicline side effects....or should I not be?

Love that you brought this up- most psychiatrists ignore this or only care if they have to adjust Zyprexa/Clozapine doses, but a lot of work done by Judith Prochaska and others has shown overall improved outcomes for psychiatric patients when smoking is aggressively targeted. My PI is very big into this (started out and became famous with doing huge GWAS studies on smoking and is now focused on dissemination/implementation, so I am doing big data research in this area).

I always go with Chantix as a first line. Post marketing data showed no increased incidence of neuropsychiatric side effects, and the recent EAGLES trial published in The Lancet recently reified this, and it also suggested that Chantix is the most effective: https://www.ncbi.nlm.nih.gov/pubmed/27116918

That said, on the inpatient unit it is basically malpractice to not give NRT (to treat withdrawal but to also focus on post discharge smoking- again, see Prochaska's work), and the intention should be to continue it as an outpatient. I also use plenty of NRT in the clinic, but I haven't as much success with it. I haven't had much success with Wellbutrin, but some of my colleagues have.

I also really like mindfulness based smoking, (but I think it is malpractice to not recommend pharmacotherapy as well): http://www.npr.org/2016/06/24/483123383/can-mindfulness-help-you-quit-smoking

 

[st2205]

For the most part it's time limited. Go ahead and use all of the above.

 

[clausewitz2]

Have mostly done smoking cessation counseling with folks who are dual-diagnosed, so Wellbutrin ends up being a much more popular and adhered-to choice, for fairly obvious reasons.

 

[J ROD]

NRT and Wellbutrin