Psychiatry/Smoking cessation drugs

Smoking cessation

also: nicotine replacement · varenicline · bupropion · NRT

Overview

Pharmacological smoking-cessation aids — NRT, varenicline and bupropion, alongside behavioural support.

Mechanism

NRT supplies nicotine without the tar/CO. Varenicline is a partial nicotinic-receptor agonist (eases craving + blunts the reward of smoking). Bupropion is a noradrenaline/dopamine reuptake inhibitor that reduces craving.

Indications

Smoking cessation

The agents

Nicotine replacement (patch + short-acting)NRT

combination

First-line; patch (background) + gum/lozenge (cravings).

Vareniclinepartial nicotinic agonist

start before quit date

Most effective single agent; monitor mood/neuropsychiatric effects, nausea, vivid dreams.

BupropionNDRI

Lowers seizure threshold — avoid in epilepsy/eating disorders.

Adverse effects

Varenicline: nausea, vivid dreams, mood changecommon

Bupropion: seizures (lowered threshold)serious

NRT: skin irritation (patch), palpitationscommon

Cautions & contraindications

Bupropion in epilepsy / eating disorders / bipolarall

Seizure threshold.

Caution in pregnancypregnancy

NRT preferred (intermittent) if needed; varenicline/bupropion avoided.

Interactions

Bupropion is a CYP2D6 inhibitor

Monitoring & kinetics

Quit progress; varenicline mood

Set a quit date; combine with behavioural support (most effective).

Source: NICE NG209 — Tobacco · BNF — Smoking cessation