Evidence
regarding the health consequences of smoking is undeniable, yet
21% of the American population continues to smoke. In addition
to behavioral modifications, first-line treatment options include
nicotine replacement therapies and bupropion SR. Varenicline,
which was recently approved by the Food and Drug Administration
(FDA), offers a novel mechanism of action for smoking cessation.
This article reviews current first-line smoking cessation aids
and evaluates the clinical trials pertaining to the efficacy and
safety of varenicline. Additionally, the authors attempt to establish
the role of varenicline in smoking cessation therapy and determine
whether varenicline should be used prior to other first-line smoking
cessation aids, particularly considering the lower costs of generic
alternatives. At present, clinical studies have not established
the efficacy of varenicline after repeated courses, following
bupropion failures, or in various unstudied populations. Relatively
poor study outcomes emphasize the need to provide patients with
behavioral counseling throughout each quit attempt and for 1 year
past the quit date.
