Combination treatment with varenicline and nicotine replacement therapy

Ebbert, Jon O.; Burke, Michael V.; Hays, J. Taylor; Hurt, R. Douglas

doi:10.1093/ntr/ntp042

Cited by 73 publications

(48 citation statements)

References 15 publications

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“…We combine NRT in the form of nicotine patches to help patients during the initial phase of titrating the dose of varenicline. A similar approach has been used in a residential smoking cessation program elsewhere [20]. Should patients have any contraindication to varenicline, then bupropion (for 12 weeks, titrated from 150 mg per day for 3 days, then increased to 300 mg per day) and NRT are used.…”

Section: Methodsmentioning

confidence: 99%

Smoking Abstinence Rates and Reasons for Failure to Quit Smoking in Cancer Patients in Jordan

et al. 2011

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Background: Failure to quit smoking in cancer patients is associated with the development of a second primary tumor and a suboptimal response to chemotherapy. However, data characterizing cancer patients' ability to quit is scarce, particularly in developing countries. Such information is valuable in highlighting the potential of cessation interventions in countries where smoking rates are high and antismoking policies are not yet fully implemented. Objectives: To measure the abstinence rates and identify reasons for the failure to quit smoking in patients visiting a smoking cessation clinic in a comprehensive cancer center in Jordan. Methods: Through retrospective medical chart review and prospective follow-up by phone, we studied long-term abstinence rates and reasons for the failure to quit smoking in 156 cancer patients referred to the smoking cessation clinic to receive counseling and pharmacological treatment. Patient demographics, clinical and smoking characteristics and long-term abstinence at 12 months were recorded, as were reasons for the failure to quit smoking. Results: The 12-month abstinence rate was 21.2%. The main reasons for failing to quit smoking included personal or professional stressful situations, not being able to handle withdrawal and the belief that quitting had no value. Conclusion: Abstinence rates in Jordanian cancer patients fall at the lower end of the range that has been reported in the literature for cancer patients. Efforts to improve these rates should focus on assisting patients in handling stress, and in adjusting medications to improve withdrawal symptoms.

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Section: Methodsmentioning

confidence: 99%

Smoking Abstinence Rates and Reasons for Failure to Quit Smoking in Cancer Patients in Jordan

et al. 2011

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“…With regards to first-line pharmacologic management, smokers are started on the indicated dose of varenicline (0.5mg daily during days 1-3, to 0.5mg twice a day during days 4-7, 1.0mg twice a day until the end of treatment) or bupropion (150mg daily during days 1-3, followed by 150mg twice a day until the end of treatment), in combination with nicotine replacement therapy (nicotine patches and nicotine lozenges or gum -NRT is prescribed at an initially high dose proportional to the number of cigarettes smoked by the patient, and titrated down towards the end of treatment). NRTs are combined with oral agents (varenicline or bupropion) to help patients during the initial phase of up-titrating the dose of either oral agent, and to control acute urges and withdrawal symptoms that may continue to occur in the first few weeks of therapy after completely quitting [with regards to varenicline and NRT in particular, a similar approach has been used in a residential smoking cessation program elsewhere (Ebbert et al, 2009)]. The choice between varenicline and bupropion is determined by clinical factors such as existence of contraindications to either drug, and the presence of comorbidities (e.g.…”

Section: Settingsmentioning

confidence: 99%

Smoking Cessation Treatment and Outcomes in Medium to Heavy Cigarette Smokers being Treated for Cancer in Jordan

Hawari¹,

Obeidat²,

Ayub³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: Studies evaluating smoking cessation treatment outcomes in cancer patients are scarce, despite smoking cessation importance in cancer care. We sought to add to the literature by evaluating smoking cessation in a challenging group of cancer patients (medium-to-heavy smokers) visiting an out-patient smoking cessation clinic (SCC) in a cancer center in Amman, Jordan. Materials and Methods: Patients smoking >9 cigarettes per day (CPD) and referred to the SCC between June 2009 and May 2012 were studied. Clinic records were reviewed to measure demographic and baseline clinical characteristics, and longitudinal (3-, 6-and 12-month) followup by phone/clinic visit was conducted. At each follow-up, patients were asked if they experienced medication side-effects, if they had returned to smoking, and reasons for failing to abstain. Descriptive and multivariable logistic regression analyses were performed. Results: A total of 201 smokers were included in the analysis. The 3-month abstinence was 23.4% and significantly associated with older age, being married, and presenting with lower (≤10ppm) baseline carbon monoxide (CO) levels. On a multivariable level, lower CO levels, a higher income (relative to the lowest income group), being older, and reporting severe dependence (relative to dependence reported as 'somewhat' or 'not') were significant predictors of higher odds of abstinence at three months. Reasons for failing to quit included not being able to handle withdrawal and seeing no value in quitting. Longterm ARs did not reach 7%. Conclusions: In a sample of Jordanian smokers (>9CPD) with cancer and receiving smoking cessation treatment, ARs were low and further declined with time. Results underscore the need for more aggressive patient management and rigorous follow-up during and after smoking cessation treatment, particularly when this takes place in challenging settings. Observed reasons for failure to abstain should be used to tailor counseling practices.

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“…Recently, investigators have evaluated the combination of varenicline, the newest cessation medication, with other therapies. Ebbert et al [37] reported a case series of smokers who used varenicline plus NRT (n=104) compared with usual care smokers who were treated prior to the release of varenicline (n=135). They found that the combination of varenicline with NRT was safe and well-tolerated in a residential tobacco treatment program [37].…”

Section: Advances In Pharmacotherapymentioning

confidence: 99%

Smoking as a Chronic Disease

Steinberg

Schmelzer

Lin

et al. 2010

Curr Cardio Risk Rep

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Despite remaining the leading cause of preventable death in the United States, tobacco smoking does not garner the attention it deserves in the medical and public health communities. Smoking is often referred to merely as a "bad habit" that simply requires adequate willpower to conquer effectively. Fortunately, recent attitudes regarding smoking, as illustrated by the latest US Public Health Service Clinical Practice Guidelines, call for a "chronic disease model" for treating tobacco dependence. This article underscores the importance of viewing smoking as a chronic disease by illustrating the effects on morbidity and mortality, discussing the relapsing nature of addiction, outlining the need for continuum of care for different "severities" of illness, and describing the latest research regarding effective treatment components. Tobacco dependence treatments are safe, effective, and cost-saving, and their use should be encouraged and covered by health insurance analogous to other chronic conditions.

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Combination treatment with varenicline and nicotine replacement therapy

Abstract: Our findings suggest that combination therapy with varenicline and NRT is safe and well tolerated among patients in a residential tobacco treatment program.

Cited by 73 publications

References 15 publications

Smoking Abstinence Rates and Reasons for Failure to Quit Smoking in Cancer Patients in Jordan

Smoking Abstinence Rates and Reasons for Failure to Quit Smoking in Cancer Patients in Jordan

Smoking Cessation Treatment and Outcomes in Medium to Heavy Cigarette Smokers being Treated for Cancer in Jordan

Smoking as a Chronic Disease

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