Clinical Medicine Reviews in Therapeutics

Tobacco use has complex and closely interrelated psychological and physiological determinants, nicotine appearing the main addictive agent in its compulsive use. Nicotine dependence is a life threatening disorder that requires long-term management. The most effective approach to increase the smoking cessation rate combines both pharmacotherapy and no pharmacological interventions.

The three major pharmacotherapies (nicotine replacement therapy, varenicline and bupropion) for which efficacy as aid to stop smoking has been proved, are summarized in this review according to their mechanism of action, metabolism, pharmacokinetic profile, efficacy, adverse events and safety. NRT has no contraindications of its use in any patient, varenicline is until now the most effective medication and bupropion allows preventing weight gain during the smoking cessation attempt. Nortriptyline is briefly described as a potential second-line medication. However there is not now one medication most effective for all smokers and there is not one standard therapy schedule: the place of these therapies must be considered according to the characteristics and the preference of the patients.