P1.2 Treatment of nicotine dependence

Treatment of nicotine dependence is effective and should be offered to smokers in addition to counselling (Lancaster 2000) [evidence level I].

Pharmacotherapies for nicotine dependence are effective and should be offered to all nicotine dependent smokers who express an interest in quitting, except when contraindicated (Global Initiative for Chronic Obstructive Lung Disease 2016, Tobacco Use and Dependence Guideline Panel 2008) [evidence level I]. Caution is recommended in people with medical contraindications, pregnant women and adolescent smokers (Global Initiative for Chronic Obstructive Lung Disease 2016). Nicotine patches, varenicline and bupropion sustained release are all PBS listed for smoking cessation. Details of PBS listing are available are available in the RACGP smoking cessation guidelines (http://www.racgp.org.au/your-practice/guidelines/smoking-cessation/) and the Australian Medicines Handbook (https://shop.amh.net.au/).

A Cochrane network analysis concluded that combination NRT (nicotine patch combined with a quick-acting oral form) and varenicline (used as monotherapy) are the most effective forms of drug treatment and work equally well. It has been shown that varenicline is more effective than bupropion in a number of studies. Head to head comparisons between bupropion and NRT monotherapy have shown these medicines are equivalent to each other in efficacy (Cahill 2013).