Smoking Cessation Pharmacology

Smoking cessation treatment has two targets: the neurobiological drive to use nicotine and the routines, cues, and social exposures that trigger smoking. Medication reduces craving and withdrawal; behavioural support helps the patient respond differently when a trigger appears. The best regimen is therefore not simply the drug with the strongest average efficacy. It is the option the patient can use safely, consistently, and affordably. For Canadian adults aged 18 years and older who smoke, the Canadian Task Force on Preventive Health Care strongly recommends offering one or more cessation interventions. These include brief practitioner advice, individual or group counselling, telephone or SMS support, self-help materials, and pharmacotherapy. Choice among varenicline, nicotine replacement therapy (NRT), bupropion, and cytisine should reflect dependence, prior quit attempts, comorbidities, adverse-effect concerns, interactions, patient preference, and provincial or territorial coverage. Adult prescribing. For adolescents and for pregnant or breastfeeding people, behavioural intervention is first-line; medication requires an individualized risk-benefit assessment, with NRT generally preferred when pharmacotherapy is used. Nurse practitioner prescribing must also remain within the applicable provincial or territorial authority, the Canadian product monograph, and...