[Nicotine preparations and other preparations for smoking cessation]

Nicotine replacement therapy doubles quit rates in smoking cessation with or without adjunct behavioural therapy; however, absolute quit rates are higher with adjunct therapy. Effective therapies include the nicotine gum, transdermal preparations, inhaler and spray. Highly dependent smokers should be offered high dose gum (4 mg) or nicotine spray. The nicotine inhaler offers more habit replacement than any of the other forms of nicotine administration and is appropriate for smokers who are moderately addicted and need something to do with their hands. Use of nicotine replacement therapy is safe for most patients with cardiovascular disease, but should probably be restricted in pregnancy to heavy smokers who are unable to quit. Bupropion, a modest dopamine and noradrenaline reuptake inhibitor, increases quit rates compared with placebo. Future therapies will include combinations of nicotine replacement products, and combinations of nicotine products with other medications. Some smokers may benefit from longer treatment and more gradual withdrawal than present treatment regimens imply.