The medicines information centre at RGH has been asked many times for advice on the most appropriate medication to aid smoking cessation in a patient with a diagnosis of depression. With the recent listing of nicotine replacement patches for subsidised supply through the Pharmaceutical Benefit Scheme for concession card holders, it is timely to review important clinical interactions with the three currently available therapeutic agents used as an aid to smoking cessation and their use in combination with antidepressant therapy.
The three available agents: buproprion (Zyban®), nicotine replacement therapy (NRT) and varenicline (Champix®); all have similar efficacy rates in assisting with smoking cessation. Regular counselling and support (such as via the Australian government sponsored Quitline, telephone 137848) is known to increase quit rates (with or without additional pharmacological treatment) as these approaches aid motivation and provide behavioural skills to enable continued abstinence.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
Tagged as:
antidepressants,
buproprion,
nicotine,
RGH E-bulletin,
Smoking Cessation,
varenicline
Tobacco smoking, and cessation of tobacco smoking, is known to affect the handling of various medications. However the significance of the effect smoking can have on medications may not always be considered in clinical practice. As many hospitals and health services (including RGH) work towards becoming smoke-free environments it is timely to highlight potential interactions involving smoking, smoking cessation and medications.
Pharmacodynamic interactions alter the expected response or actions of other drugs. In the case of tobacco smoke, these interactions are largely due to nicotine. Pharmacodynamic interactions with medications and smoking include:
• Combined hormonal contraceptives – risk of cardiovascular disease is increased for women who smoke
• Inhaled corticosteroids – cigarette smoking in asthma is associated with a reduced sensitivity to corticosteroids
• Beta blockers – nicotine stimulation of the sympathetic nervous system may counteract the effects of these drugs
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The 2009 RGH E-Bulletins are archived here.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
Tagged as:
CYP1A2,
Medications,
RGH E-bulletin,
smoking,
Smoking Cessation
