Section - Video Lectures

07. Approved and Off-Label Pharmacotherapy for Tobacco Use Disorder

Published on June 1, 2020 Expired on April 1, 2025

Joji Suzuki, M.D.

Assistant Professor of Psychiatry - Harvard Medical School

Key Points

Nicotine replacement, varenicline, and bupropion can be tried in combination with psychosocial interventions and other pharmacotherapies.
Patient preference is critical in deciding which agent to use.
Prematurely giving up on pharmacotherapy due to prior failure may be counterproductive.

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Slides and Transcript

Slide 1 of 5

Let’s move on to Describing Currently Approved and Off-label Pharmacotherapy for Tobacco Use Disorder. And so why will we consider pharmacotherapy above and beyond psychosocial interventions that I just described? Combining pharmacotherapy improves outcomes especially when combined with psychosocial interventions. It dramatically reduces withdrawal and cravings and this allows patients to focus on the psychological aspects of recovery and quitting beyond managing the withdrawal and cravings.

Approved and Off-Label Pharmacotherapy for Tobacco Use Disorder Slide 1 of 5

Slide 2 of 5

Now, the first-line pharmacotherapies currently which are all FDA approved include nicotine replacement, bupropion and varenicline. And I’ll be describing each of these approaches separately. Second-line treatment includes nortriptyline and clonidine but these are not FDA approved.

References:

Hughes, J. R., Stead, L. F., Hartmann‐Boyce, J., Cahill, K., & Lancaster, T. (2014). Antidepressants for smoking cessation. Cochrane database of systematic reviews, (1).
Gonzales, D., Rennard, S. I., Nides, M., Oncken, C., Azoulay, S., Billing, C. B., … & Varenicline Phase 3 Study Group. (2006). Varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. Jama, 296(1), 47-55.
Jorenby, D. E., Hays, J. T., Rigotti, N. A., Azoulay, S., Watsky, E. J., Williams, K. E., … & Varenicline Phase 3 Study Group. (2006). Efficacy of varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. Jama, 296(1), 56-63.

Approved and Off-Label Pharmacotherapy for Tobacco Use Disorder Slide 2 of 5

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08. Using Nicotine Replacement Therapies in Practice: Pros and Cons, Cautions, and a Guide on Nicotine Gum

Learning Objectives:

After completing this activity, the learner will be able to:

Summarize the effects of nicotine in the body and recognize withdrawal symptoms.
Learn strategies for speaking with patients about tobacco addiction and how to help them decide to quit.
Identify available treatment options so as to prescribe the best choice for a given patient.

Original Release Date: 06/01/2020

Review and Re-release Date: 03/01/2024

Expiration Date: 04/01/2025

Expert: Joji Suzuki, M.D.

Medical Editor: Jessica Diaz, M.D

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationship(s) to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 1.00 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.