Beating nicotine: Medication algorithm helps teens quit
For motivated daily smokers, benefits of pharmacotherapy may outweigh the risks.
Dosing guidelines for adolescent smoking cessation therapy
| Medication | Recommended regimen |
|---|---|
| Bupropion SR31 | Patient weight ≥90 lbs: 150 mg once in the morning for 3 to 6 days, then 150 mg bid for 12 weeks Patient weight <90 lbs: Maximum 150 mg once in the morning, if tolerated |
| Transdermal NRT28 | Patient smokes ≥10 cpd: 21 mg/d for 6 weeks, then 14 mg/d for 2 weeks, then 7 mg/d for 2 weeks, then discontinue Patient smokes <10 cpd: 14 mg/d for 6 weeks, then 7 mg/d for 2 weeks, then discontinue |
| cpd: cigarettes per day; NRT: nicotine replacement therapy | |
CASE CONTINUED: Staying smoke-free
Upon discharge, Michael discontinued NRT and followed up with his outpatient psychiatrist, who provided brief smoking cessation counseling in addition to bupropion SR, 150 mg bid. Michael’s depressive symptoms improved with the medication. He was able to stop smoking within 3 months with the combination of medication and behavioral therapy.
- Centers for Disease Control and Prevention, Youth Tobacco Prevention. www.cdc.gov/tobacco/youth/index.htm.
- Not On Tobacco model program. Substance Abuse and Mental Health Services Administration.www.modelprograms.samhsa.gov/pdfs/model/Not_On_Tobacco.pdf.
Drug brand names
- Bupropion SR • Zyban
- Clonidine • Catapres
- Doxepin • Sinequan
- Mecamylamine • Inversine
- Nicotine/inhalation system • Nicotrol Inhaler
- Nicotine/lozenge • Commit
- Nicotine/nasal spray • Nicotrol NS
- Nicotine/polacrilex • Nicorette
- Nicotine/transdermal • Nicotrol, Prostep
- Nortriptyline • Pamelor
- Selegiline • Eldepryl
- Varenicline • Chantix
Disclosures
Dr. Verduin has received research/grant support from the National Institute of Drug Abuse.
Dr. Upadhyaya is a consultant and speaker for Shire Pharmaceuticals and has received grant/research support from and is a consultant to Eli Lilly and Company.
