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Giving up smoking: motivation and moral support first, and then, if necessary, nicotine

The role of drugs in helping smokers quit remains secondary. If medicinal aid is deemed necessary, it is best to keep to nicotine.

Varenicline, a new drug for the treatment of tobacco addiction, has been announced. The aim of treating tobacco addiction is for the smoker to give up smoking permanently. To achieve this, the patient's motivation and moral support are crucial. Drugs play a secondary role and, if a drug prescription is required, nicotine, which comes in many forms and dosages, is the drug with the most favourable benefit-harm balance.

Bupropion, an amphetamine drug with a negative benefit-harm balance, should be avoided in treating tobacco addiction.

In the absence of a direct comparison between the two drugs, it has not yet been established whether varenicline's benefit-harm balance is more positive than that of nicotine. The adverse effects of varenicline seem moderate, but it is too early to tell. The combination of nicotine + varenicline exacerbates the adverse effects of nicotine.

Overall, the usefulness of drugs in helping smokers quit is limited, but when medicinal help is deemed appropriate, nicotine remains the first-line drug.

©Prescrire October 2006

Source: "Varénicline (Champix°). Sevrage tabagique : pas mieux que la nicotine" Rev Prescrire 2006 ; 26 (276) : 645-648.

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