Madison Clinic
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Smoking Cessation

  • US Public Health Service suggests “5 Rs” to motivate patients to quit smoking:
    • Encourage patient to think of Relevance of quitting smoking to their lives
    • Assist patient in identifying the Risks of smoking
    • Assist the patient in identifying Rewards of smoking cessation
    • Discuss with patient Roadblocks or barriers to attempting cessation
    • Repeat the motivational intervention at all visits
  • SMK Cessation can be initiated by following the smoking cessation algorithm (19kb PDF).
  • Referrals can be made through the 2WC clinic front desk to schedule appointment/classes with Ji Lee or Robert Santucci in the Pharmacy for Madison Clinic Patients.
  • For those patients who do not wish to attend classes (counseling or classes are preferred) but are motivated to quit on their own, materials are available to assist them in quitting:

www.surgeongeneral.gov/tobacco/lowlit.htm

www.quitline.com

  • These patients may also be willing to pay out-of-pocket for medications, the following are available at these costs at HMC: Prices may vary depending on the product in stock.
    • Nicotine 21-mg patch/day once daily for 4–8 weeks (remove and replace every 24 hours). Then 14-mg patch/day for 2–4 weeks followed by 7 mg patch/day for 2–4 weeks. Patients who are thin (<50 kg) or smoke <half ppd may do fine with 14-mg patch to start.
    • Bupropion (Zyban®) - Also comes as generic bupropion SR. Begin 1–2 weeks before quit date 150 mg every day for 3 days then 150 mg twice daily through end of therapy (max 7–12 weeks). Avoid if seizure disorder.
    • Varenicline (Chantix®) - Begin 0.5 mg once daily on days 1–3, then 0.5 mg twice daily on days 4–7, then 1 mg twice daily through end of therapy (12 weeks, consider additional 12 weeks to prevent relapse). Caution in renal disease patients; adjust dose if CrCl <50
    • Nortriptyline is an inexpensive 2nd line option for nicotine craving: 25 mg PO qHS 7-10 days prior to quit date, then 75 mg PO qHS x 8-12 week. Consult with pharmacy regarding tapering off.

Helpful Links

http://www.ahrq.gov/path/tobacco.htm

 

 

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