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John R. Hughes, MD; Michael G. Goldstein, MD; Richard D. Hurt, MD; Saul Shiffman, PhD

JAMA. 1999;281:72-76.

Since the 1996 publication of guidelines on smoking cessation from the Agency for Health Care Policy and Research and the American Psychiatric Association, several new treatments have become available, including nicotine nasal spray, nicotine inhaler, and bupropion hydrochloride. In addition, nicotine gum and patch have become available over-the-counter. This article reviews the published literature and US Food and Drug Administration and pharmaceutical company reports on these therapies. Based on this review, clinical logic, and experience, we conclude that pharmacotherapy should be made available to all smokers. All currently available therapies appear to be equally efficacious, approximately doubling the quit rate compared with placebo. Concomitant behavioral or supportive therapy increases quit rates and should be encouraged but not required. Combining patch with gum or patch with bupropion may increase the quit rate compared with any single treatment. Because patient characteristics predictive of success with a particular therapy are not yet known, the best treatment choice for an individual patient should be guided by the patient's past experience and preference and the product's adverse effect profile.

Author Affiliations: Department of Psychiatry, University of Vermont, Burlington (Dr Hughes); Department of Psychiatry, Brown University, Providence, RI (Dr Goldstein); Nicotine Dependence Center, Mayo Clinic, Rochester, Minn (Dr Hurt); and Department of Psychology, University of Pittsburgh, Pittsburgh, Pa (Dr Shiffman).

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