TABLE 375-3 - Clinical Practice Guidelines

Physician actions

Ask: Systematically identify all tobacco users at every visit

Advise: Strongly urge all smokers to quit

Identify smokers willing to quit

Assist the patient in quitting

Arrange follow-up contact


Pharmacologic interventions—first-line therapies

Nicotine gum (1.5)

Nicotine 24-h patch: 21-mg patch for 4 weeks, 14-mg patch for 2 weeks, and 7-mg patch for 2 weeks (1.9)

Nicotine nasal inhaler: one spray to each nostril 1–2 times/h for 3–6 months (2.7)

Nicotine oral inhaler: 6–16 puffs per day for up to 6 months (2.5)

Bupropion: 150 mg/d PO for 3 days followed by 150 mg bid for 7–12 weeks (2.1)


Pharmacologic interventions—second-line therapies

Clonidine: Initial dose 0.1 mg bid PO, or 0.1-mg transdermal patch, increasing to 0.15–0.75 mg/d PO or 0.2-mg patch for 3–10 weeks (2.1)

Nortriptyline: Initial dose 25 mg/d PO, increasing to 75–100 mg/d for 12 weeks (3.2)

Other interventions

Physician or other medical personnel counseling, 10 minutes (1.3)

Intensive smoking cessation program_a (2.3)

Clinic-based smoking status identification system (3.1)

Counseling by nonclinicians and social support by family and friends

Telephone counseling (1.2)

Note: Numerical value in parentheses is the multiple for cessation success compared to no intervention.

_aAt least four to seven sessions of 20- to 30-min duration, lasting at least 2 weeks, preferably 8 weeks.