(HealthDay News) — Varenicline is strongly recommended over the patch for adult smokers hoping to quit, according to an American Thoracic Society practice guideline published online the American Journal of Respiratory and Critical Care Medicine.

Frank T. Leone, MD, from the University of Pennsylvania in Philadelphia, and colleagues from the American Thoracic Society prioritized questions and outcomes important to clinicians and then conducted systematic reviews to arrive at the evidence-based guideline for initiating pharmacologic therapy in tobacco-dependent adults.

The guideline included 5 strong recommendations and 2 conditional recommendations regarding pharmacotherapy choices. Using varenicline rather than a nicotine patch, varenicline rather than bupropion, and varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition all received strong recommendations. Additionally, initiating varenicline in adults even if they are unready to quit and using controller therapy for an extended treatment duration >12 weeks were also strong recommendations. Combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes received conditional recommendations.

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“Introducing the optimal controller to patients before they express willingness to quit results in an additional 308 patients achieving abstinence per 1000 patients treated,” Leone said in a statement.


Leone FT, Zhang Y, Evers-Casey S, et al. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline. Am J Resp Crit Care Med.