A review of nonpharmacologic and pharmacologic therapies for smoking cessation

Cigarette smoking is one of the leading causes of the development of cardiovascular disease and premature death among men and women in the United States. Smoking is associated with increased morbidity and mortality among both smokers and nonsmokers who are exposed to secondhand smoke. Smoking cessation can improve the health and overall outcomes of smokers almost immediately. Multiple attempts at cessation are often necessary to achieve complete abstinence because of the highly addictive properties of nicotine. Many treatment options, both nonpharmacologic and pharmacologic, are available to assist patients who are attempting to quit smoking. Cognitive behavior therapy has been demonstrated to be efficacious, prolonging abstinence rates when used in combination with pharmacologic therapy. Traditional pharmacologic therapies, including nicotine replacement therapy and bupropion, have been demonstrated to be effective in patients who are attempting smoking cessation. The approval of varenicline, the newest agent for smoking cessation, has provided clinicians with an additional treatment option. Clonidine and nortriptyline, although not approved by FDA for smoking cessation, have also been studied in this patient population; results have been conflicting.