Treatment Guidelines from The Medical Letter
Drugs for Tobacco Dependence
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Revised 10/6/10: Table 1: Some footnotes were renumbered.

Tobacco dependence is a chronic disease that often requires pharmacological therapy, but counseling improves the effectiveness of any treatment for this indication. The greater the number of office visits and the longer the counseling time, the higher the smoking cessation rates have been.1


NICOTINE — All nicotine replacement therapies (NRTs) deliver nicotine, which acts as an agonist at the nicotinic acetylcholine receptor, to the central nervous system (CNS) in a lower dose and at a substantially slower rate than tobacco cigarettes. All of these products roughly double smoking cessation rates.2 Nicotine is subject to first-pass metabolism, limiting the effectiveness of oral pill formulations. Nicotine gum, lozenges and patches are available without a prescription in the US; these products appear to be ... more      

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