Details

Autor(en) / Beteiligte

• Hays, J. Taylor
• Ebbert, Jon O

Titel

Varenicline for Tobacco Dependence

Ist Teil von

• The New England journal of medicine, 2008-11, Vol.359 (19), p.2018-2024

Ort / Verlag

Boston, MA: Massachusetts Medical Society

Erscheinungsjahr

2008

Quelle

EZB-FREE-00999 freely available EZB journals

Beschreibungen/Notizen

• A 57-year-old man presents to his primary care provider because he would like to quit smoking. A trial of varenicline, a partial agonist of the nicotinic acetylcholine receptor that has been shown to increase rates of smoking abstinence as compared with placebo, is recommended. In light of reports of neuropsychiatric side effects, including suicidal behavior, patients treated with varenicline should be closely monitored for behavioral symptoms. A 57-year-old man presents to his primary care provider because he would like to quit smoking. A trial of varenicline, a partial agonist of the nicotinic acetylcholine receptor, is recommended. In light of reports of neuropsychiatric side effects, including suicidal behavior, patients treated with varenicline should be closely monitored for behavioral symptoms. Foreword This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the authors' clinical recommendations. A 57-year-old man with a 60-pack-year history visits his primary care provider because he wants to quit smoking. He has a history of stable coronary artery disease, peripheral vascular disease, and hypertension. He also has severe obstructive lung disease (forced expiratory volume in 1 second, 39% of the predicted value) with a progressive increase in dyspnea. He has quit smoking and has had numerous relapses; the longest duration of abstinence from smoking was 7 months. Each relapse involved casual smoking to “test himself.” During previous attempts to quit, he has used a nicotine patch, a nicotine inhaler, and sustained-release bupropion. He feels motivated to quit smoking because he recently heard about a new medication to aid in quitting, and he wants to improve his health. The patient and his physician discuss the therapeutic options and agree that varenicline (Chantix) may be an option. The Clinical Problem Cigarette smoking is the most preventable cause of illness, death, and excess health care costs in the United States, 1 , 2 accounting for more than 440,000 deaths annually and $157 billion in health-related economic losses. 3 In the adult population, annual smoking-related deaths are attributed primarily to lung cancer (125,000 deaths), ischemic heart disease (82,000), and chronic obstructive pulmonary disease (65,000). 3 Cigarette smoking accounts for 30% of all deaths from cancer in the United States. Smoking is a major risk factor for cancers of the lungs, larynx, oral cavity, pharynx, and esophagus. Cigarette smoking is also causally related to . . .