A 35 year old female came to your OPD for smoking cessation. She was diagnosed with depression 2 years ago and took SSRI for 6 months. She is off medication for 1.5 years & now is mentally healthy. She staed smoking at the age of 25 years & she tried quitting on her own using nicotine gums several times but she is unable to sustain abstinence for more than 1 month. What would be the best recommendation in this patient?

The answer is D. A comprehensive approach with advice, pharmacological assistance & counselling increase the cessation success. At every medical visit, all patients should be asked whether they smoke, how much they smoke, and whether they are interested in quitting. * Pharmacologic therapy- Nicotine replacement therapy (N) or varenicline Ns- transdermal patches, nasal inhaler, gum, oral inhaler, or lozenges * Varenicline- paial agonist of the nicotinic acetylcholine receptor Counselling: Physician/medical personnel counselling Intensive individual counselling Telephone counselling Effective Pharmacologic Interventions for smoking cessation: First-line therapies (Number in brackets indicates efficacy): 1. Nicotine gum (1.5) 2. Nicotine patch (1.9) 3. Nicotine nasal inhaler (2.7) 4. Nicotine oral inhaler (2.5) 5. Nicotine lozenges (2.0) 6. Bupropion (2.1) 7. Varenicline (2.7) Second-line therapies 1. Clonidine (2.1) 2. Noriptyline (3.2)