Evidence-Based Reviews

Beating nicotine: Medication algorithm helps teens quit

Current Psychiatry. 2007 October;6(10):65-74

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Dosing guidelines for adolescent smoking cessation therapy

Medication	Recommended regimen
Bupropion SR³¹	Patient weight ≥90 lbs: 150 mg once in the morning for 3 to 6 days, then 150 mg bid for 12 weeks Patient weight <90 lbs: Maximum 150 mg once in the morning, if tolerated
Transdermal NRT²⁸	Patient smokes ≥10 cpd: 21 mg/d for 6 weeks, then 14 mg/d for 2 weeks, then 7 mg/d for 2 weeks, then discontinue Patient smokes <10 cpd: 14 mg/d for 6 weeks, then 7 mg/d for 2 weeks, then discontinue
cpd: cigarettes per day; NRT: nicotine replacement therapy

CASE CONTINUED: Staying smoke-free

Upon discharge, Michael discontinued NRT and followed up with his outpatient psychiatrist, who provided brief smoking cessation counseling in addition to bupropion SR, 150 mg bid. Michael’s depressive symptoms improved with the medication. He was able to stop smoking within 3 months with the combination of medication and behavioral therapy.

Related resources

Centers for Disease Control and Prevention, Youth Tobacco Prevention. www.cdc.gov/tobacco/youth/index.htm.
Not On Tobacco model program. Substance Abuse and Mental Health Services Administration.www.modelprograms.samhsa.gov/pdfs/model/Not_On_Tobacco.pdf.

Drug brand names

Bupropion SR • Zyban
Clonidine • Catapres
Doxepin • Sinequan
Mecamylamine • Inversine
Nicotine/inhalation system • Nicotrol Inhaler
Nicotine/lozenge • Commit
Nicotine/nasal spray • Nicotrol NS
Nicotine/polacrilex • Nicorette
Nicotine/transdermal • Nicotrol, Prostep
Nortriptyline • Pamelor
Selegiline • Eldepryl
Varenicline • Chantix

Disclosures

Dr. Verduin has received research/grant support from the National Institute of Drug Abuse.

Dr. Upadhyaya is a consultant and speaker for Shire Pharmaceuticals and has received grant/research support from and is a consultant to Eli Lilly and Company.