Actualities in first-line pharmacotherapy for smoking cessation support

Smoking is still one of the most significant public health problems in Hungary. The issue of smoking cessation support comes up in most medical specialties. Therefore, a summary of the current pharmacotherapeutic knowledge may prove useful to the medical community. In this paper, we review the first-line pharmacotherapy for smoking cessation based on the latest summaries and guidelines. Regarding the smoking cessation agents, varenicline and nicotine replacement therapy are currently the primary choice, not only in terms of cessation but also in terms of harm reduction. The results of previous studies suggest that the efficacy of low dose varenicline is close to that of standard dosing, with fewer side effects. With regard to nicotine replacement therapy, it should be emphasized that there is an increasing scientific evidence for the combination of transdermal and oral formulations as opposed to monotherapy. Low dose varenicline and nicotine replacement therapy also help reduce the number of cigarettes smoked daily if the client does not want to quit but would reduce the harms of smoking. The role of medications acting in other ways than the nicotinergic system has also emerged. An increasing number of reviews support the use of antidepressants in the treatment of nicotine addiction. Of these, most data are available on the use of bupropion, which is known to be combined with nicotine replacement therapy and varenicline. In all cases, it is advisable to combine pharmacotherapy with behavioral therapy as well as interventions that increase adherence. In addition, it is also recommended to include specific therapeutic interventions in order to get as much help as possible for the patient to quit smoking.