Pharmacotherapy of Tobacco Cessation

Ironically after five centuries tobacco has gone from a medicinal plant to one of the worst world public health issues. Nicotine is the primary component of tobacco. It is recognized as one of the most frequently used addictive drugs and it is very important for tobacco users to quit. Counselling is an effective and cost-effective method for smoking cessation but counselling alone may not be useful for chronic smokers and its effectiveness can be improved by simultaneous pharmacotherapy. Pharmacological intervention leads to a near doubling of cessation rates achieved by non-pharmacological intervention irrespective of the level of that intervention. It will therefore increase the chance of success with any quit attempt but is most effective when combined with intensive behavioural support. Several randomized double-blind placebo- controlled trials related to pharmacotherapy have reported significantly higher abstinence rates with first-line and some second-line drugs compared with placebo. These clinical trials provide scientific evidence of the efficacy and safety of nicotine replacement therapy (NRT) bupropion varenicline as first line drugs and clonidine and nortriptyline used as second-line smoking cessation therapy; however the effectiveness and limitations of these drug regimens in real-life settings are still poorly documented.