Smoking Cessation

Question 1

What are the pharmacological options available to aid with smoking cessation & what are their respective forensic classes?

Answer 1

NRT: P-Only
Varenicline: POM
Bupropion: POM

Question 2

Can you use different NRTs (e.g. patch, lozenge, gum) together?

Answer 2

Yes. Combination of NRTs is 1st line especially for nicotine-dependent patients
Long-acting as basal; short-acting when craving hits

single agent also less effective

Question 3

What pharmacologics can be used for smoking cessation in pregnancy?

Answer 3

NRT

Guidelines don’t reccommend bupropion / varenicline

Question 4

What are the considerations of using NRT in pregnancy?

What can be done with regards to this?

Answer 4

Metabolism of nicotine in pregnancy is faster –> NRT may be insufficient to help w/ cessation

Use a shorter duration patch e.g. 16h patch rather than 24h one (switch more frequently) & add short-acting NRT (gum/lozenge)

remove patch when sleeping!!