P1.2 Treatment of nicotine dependence

Pharmacotherapies for nicotine dependence are effective and should be offered to all nicotine dependent smokers who express an interest in quitting, except when contraindicated (Tobacco Use and Dependence Guideline Panel 2008, Cahill 2013) [evidence level I]. Caution is recommended in people with medical contraindications, pregnant women and adolescent smokers. 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).  In a study of 690 current smokers identified from Melbourne general practices (Liang 2018), 52.2% self-reported attempts to quit at least once during the previous 12 months.  The pharmacological treatments most frequently tried were nicotine replacement therapy (205, 57.4%) and varenicline (110, 30.8%). However, non-evidence-based treatments such as hypnotherapy (62, 17%) and electronic cigarettes (38, 11%), were also frequently tried.