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- Use specific behavioral modalities for smoking cessation, including physician advice, group behavior therapy, and self-help therapy.
 - Consider drug treatment modalities for smoking cessation, including nicotine replacement, bupropion, and varenicline.
- Know that modalities for which there is limited evidence for effectiveness or evidence against their effectiveness include anxiolytics, clonidine (which, although it has the strongest evidence of benefit, should be considered a second-line therapy due to side effects), mecamylamine, lobeline, naltrexone, and silver acetate.
- Recognize that nicotine replacement is safe in most patients, that bupropion carries some risk of adverse effects in some patients with comorbid conditions or on other drugs, varenicline was safe and well-tolerated in clinical trials that enrolled primarily healthy participants, and that the role of these agents is unclear in pregnancy.
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| Edward Ellerbeck, MD, MPH, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Kumanan Wilson, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Darren B. Taichman, MD, PhD, Editor, PIER, has received grant support from Actelion Pharmaceuticals Ltd , and honoraria for continuing medical education grand rounds and lectures given. |
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Smoking Cessation
