Pharmacotherapy of Smoking Cessation

tine addiction, including nicotine nasal spray, nicotine inhaler, bupropion hydrochloride, and over-the-counter transdermal nicotine patches, have increased the treatment options physicians can of-fer to smokers. Physicians, especially those in primary care specialties, should familiarize themselves with these products to improve efforts to help their patients stop smoking. This article reviews scientific data on the efficacy of approved medications, benefits, adverse effects, and appropriate use of these products. We also discuss nicotine addiction and treatment for special populations, including women, ethnic minorities, light smokers, and patients with cardiovascular and pulmo-nary diseases. Arch Fam Med. 2000;9:270-281 Tobacco use is the number one cause of preventable diseases in the United States. Smoking accounts for about 435 000 deaths yearly and 30 % of all cancer deaths.1 Cigarette smoking is responsible for $50 billion annually in direct medical costs, and $47 billion in indirect, nonmedical costs.2 Despite widespread efforts to educate the public on the risks of smoking, the preva-lence of smoking in the United States re-mains high. Approximately 46 million American adults are still current smok-ers.3 Although smoking prevalence for US adults has fallen from 42 % in 1965 to 25.5 % in 1997,4 the proportion of heavy smokers is higher today than 20 years ago.5 One of the goals of Healthy People 2000 is to increase by 75 % the propor-tion of primary care providers who rou-tinely provide smoking cessation coun-seling for their patients who smoke.1 Primary care clinicians have access to ap-proximately 36 million (70%) of the 50 million people who smoke, including 61% of smokers who considered themselves to be in “excellent health.”6,