Initiating Pharmacologic Treatment in Tobacco-Dependent Adults
Jain A, Davis AM. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults: JAMA Clinical Guidelines Synopsis. JAMA Network. 19 Jan 2021. https://jamanetwork.com/journals/jama/fullarticle/2775266
This American Thoracic Society guideline was written to provide evidence-based, practical guidance for the component of pharmacotherapy in smoking cessation in the US.
Strong Recommendations only:
For tobacco-dependent adults in whom treatment is being initiated, varenicline is recommended over nicotine patches and bupropion (strong recommendation, moderate certainty in the estimated effects).
In tobacco-dependent adults who are not ready to discontinue tobacco use, clinicians are recommended to begin treatment with varenicline rather than waiting until patients are ready to stop tobacco use (strong recommendation, moderate certainty).
For tobacco-dependent adults with comorbid psychiatric conditions, varenicline is recommended over a nicotine patch (strong recommendation, moderate certainty).
For tobacco-dependent adults in whom controller pharmacotherapy (eg, patch or varenicline) is being initiated, extended-duration therapy (>12 weeks) is recommended over standard-duration therapy (6-12 weeks) (strong recommendation, moderate certainty).
Note: Even in the US where e-cigarettes have sometimes been used, this guideline does not recommend e-cigarettes.
Stephen Hamann
