SmokersQuit

SmokersQuit

A Guide for Clinicians

1 - 8 0 0 - Q U I T N O W

National Quitline

1 - 8 0 0 - Q U I T N O W

Even brief tobacco dependence treatme

is effective and should be offered to eve

patient who uses tobacco.

Even brief tobacco dependence treatme

is effective and should be offered to eve

patient who uses tobacco.

U.S. Department of Health and Human Services

Public Health Service

Revised May 2008

open for medication chart

PHS Clinical Practice Guideline

Treating Tobacco Use and Dependence: 2008 Update
Ask about 

tobacco use at

every visit.

Implement a system in your clinic that ensures that

tobacco-use status is obtained and recorded at every

patient visit.

VITAL SIGNS

Blood Pressure: __________________________________________

Pulse: ________________ Weight: ________________

Temperature: ____________________________________________

Respiratory Rate: ________________________________________

Tobacco Use: Current Former Never

(circle one)

Ask about 

tobacco use at

every visit.

Ask
Advise

Advise all 

tobacco 

users to quit.

Use clear, strong, and personalized language.

For example,

“Quitting tobacco is the

most important thing you

can do to protect your

health.”

Advise all

tobacco 

users to quit.

Advise
Assess 

readiness 

to quit.

Ask every tobacco user if he/she is willing to quit at

this time.

If willing to quit, provide resources and assistance 

(see Assist section).

If unwilling to quit at this time, help motivate the 

patient:

• Identify reasons to quit in a supportive manner.

• Build patient’s confidence about quitting.

Assess Assess

Assess 

readiness 

to quit.
Assist

tobacco

users with a 

quit plan.

Assist the smoker to:

Set a quit date, ideally within 2 weeks.

Remove tobacco products from their environment.

Get support from family, friends, and coworkers.

Review past quit attempts—what helped, what led to

relapse.

Anticipate challenges, particularly during the critical

first few weeks, including nicotine withdrawal.

Identify reasons for quitting and benefits 

of quitting.

Assist

(more)

Assist

tobacco

users with a 

quit plan.
(Assist continued)

Give advice on successful quitting:

Total abstinence is essential—not even a single puff.

Drinking alcohol is strongly associated with relapse.

Allowing others to smoke in the household hinders 

successful quitting.

Encourage use of medication:

Recommend use of over-the-counter nicotine patch,

gum, or lozenge; or give prescription for varenicline,

bupropion SR, nicotine inhaler, or nasal spray, unless

contraindicated.

Provide resources:

Recommend toll free 1-800-QUIT NOW (784-8669),

the national access number to State-based quitline 

services.

Refer to Web sites for free materials:

• Agency for Healthcare Research and Quality: 

www.ahrq.gov/path/tobacco.htm

• U.S. Department of Health and Human Services:

www.smokefree.gov
Arrange

followup

visits.

Schedule followup visits to review progress toward

quitting.

If a relapse occurs, encourage repeat quit attempt. 

Review circumstances that caused relapse. Use 

relapse as a learning experience.

Review medication use and problems.

Refer to 1-800-QUIT NOW (784-8669).

For more information on prescribing, precautions, and side effects, 

see the Public Health Service Clinical Practice Guideline, Treating

Tobacco Use and Dependence: 2008 Update, 

www.ahrq.gov/path/tobacco.htm. 

Arrange Arrange

Arrange

followup

visits.
Suggestions for the Clinical Use of Medications for Tobacco Dependence Treatmenta

Medication Precautions/Contraindications Side Effects Dosage Duration Availability

Nicotine Patch Local skin reaction 21 mg/24 hours 4 weeks Prescription and OTCb

Insomnia 14 mg/24 hours then 2 weeks

7 mg/24 hours then 2 weeks

Nicotine Gum Mouth soreness 1-24 cigs/day-2mg gum Up to 12 weeks OTCb only 

Dyspepsia (up to 24 pcs/day)

25+ cigs/day-4 mg gum

(up to 24 pcs/day)

Nicotine Nasal Spray Nasal irritation 8-40 doses/day 3-6 months Prescription only

Nicotine Inhaler Local irritation of 6-16 cartridges/day Up to 6 months Prescription only 

mouth and throat

Nicotine Lozenge Local irritation of throat First am cigarette after 30 minutes 12 weeks OTCb only

Hiccups from waking: 2 mg (up to 20 pcs/day)

Heartburn/Indigestion First am cigarette before 30 minutes 

Nausea from waking: 4 mg (up to 20 pcs/day)

Bupropion SR History of seizure Insomnia 150 mg every morning for 7-12 weeks Prescription only

History of eating disorder Dry mouth 3 days then 150 mg twice daily maintenance up to 

Use of MAO inhibitors in past 14 days (Begin treatment 1-2 weeks pre-quit) 6 months

Varenicline Monitor for changes in mood, Nausea 0.5 mg once daily for days 5-7 3 months, Prescription only

behavior, psychiatric symptoms, Trouble sleeping before quit date maintenance up to 

and suicidal ideation 0.5 mg twice daily for days 1-4 6 months

before quit date

1 mg twice daily starting on quit date

aThe information contained within this table is not comprehensive. Please see medication package inserts for additional information. 

bOTC refers to over the counter.