Drug therapy includes nicotine replacement therapy and bupropionSR (also called Zyban and WellbutrinSR which are the trade names). Nicotine replacement therapy is available as a skin patch, gum, lozenge, nasal spray and inhaler. More than one of these may be used simultaneously (e.g., nicotine skin patch every morning supplemented with nicotine gum, lozenge, spray or inhaler as needed). Patient preference and tolerance guides the choice (e.g., avoid the patch in people with severe skin conditions such as eczema; avoid the gum in denture wearers; avoid the inhaler and nasal spray in severe asthmatics). The nicotine replacement agents fill the nicotine receptor in the brain and help to control nico-tine withdrawal symptoms and cravings that people experience when trying to quit smok-ing. BupropionSR (Zyban, WellbutrinSR) is an anti-depressant pill which also helps to con-trol nicotine cravings. The nicotine patch, gum and lozenges are available in pharmacies without a doctor's prescription. The nicotine nasal spray, nicotine inhaler and bupropionSR require a doctor's prescription.

Some physicians start with nicotine replacement therapy and use bupropionSR if a person does not wish to use nicotine replacement or it has failed. Other physicians start with nicotine replacement therapy plus bupropionSR since there is some preliminary evidence that the combination is more effective in the short term for smoking cessation than either therapy alone. BupropionSR therapy is prescribed two weeks before the planned quit date since it takes this amount of time to start working. Nicotine replacement therapy is started at the time of quitting. Both of these are usually continued for 2-3 months since physiologic nicotine withdrawal symptoms are usually gone well within this time. An occa-sional patient may desire long term pharmacologic therapy (e.g., 6 months or more) be-cause of strong and persistent nicotine cravings. Long term nicotine replacement thera-pies and long term bupropionSR have both been approved by the FDA for this purpose.

Smokers who are most likely to benefit from the pharmacotherapy described above are those that have signs of nicotine addiction. These include: smoking the first cigarette within thirty minutes of waking up, smoking a pack or more a day, craving cigarettes when they're not available, finding it hard to refrain from smoking for more than a few hours and smoking even when sick enough to stay in bed. Nicotine replacement products are less addictive and safer than tobacco products because they deliver smaller doses of nicotine and don't have any of the poisonous tars. They should not be used together with tobacco products since this could result in a nicotine overdose. The cost of pharmaco-therapy is roughly that of buying one pack of cigarettes per day.

In general, all smokers trying to quit should receive pharmacotherapy for smoking cessa-tion except for those smoking less than ten cigarettes/day, pregnant/breast feeding