Distúrbios mentais estáveis não contra-indicam medicações para abandono de tabagismo

Safety of smoking cessation medications in patients with and without mental health disorders

Reports of newly emergent depression, suicidal ideation, and suicidal behavior among patients receiving bupropion or varenicline for smoking cessation raised questions about the safety of these drugs in smokers with mental health disorders. In a recent trial examining the safety of these medications, more than 8000 motivated adult smokers, approximately half with clinically stable mental health disorders, were randomly assigned to varenicline, bupropion, transdermal nicotine, or placebo for 12 weeks [1]. Compared with patients without mental health disorders, patients with such disorders were more likely to experience neuropsychiatric adverse events (including anxiety, depression, agitation, or hostility) during treatment (2.1 versus 5.8 percent). However, in both patients with and without mental health disorders, the rate of events did not differ for patients assigned to varenicline or bupropion compared with placebo. Rates of smoking abstinence were higher with each of the three drugs compared with placebo, and higher with varenicline compared with bupropion or transdermal nicotine. The findings are consistent with previous, smaller trials supporting carefully monitored use of smoking-cessation medications in smokers with stable mental health disorders.

See 'Pharmacotherapy for co-occurring schizophrenia and substance use disorder', section on 'Safety'.

1. Anthenelli RM, Benowitz NL, West R, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet 2016.

Parar de fumar: Melhor parar de uma vez que diminuir aos poucos

Após decidir uma dada para parar de fumar, pacientes que param abruptamente parecem ter mais chance de sucesso do que os que diminuem até parar.

Abrupt smoking cessation compared with gradual smoking reduction

Earlier evidence from randomized trials had suggested that, after a quit date is set, abstinence rates were equivalent for patients who reduced smoking prior to the quit date or stopped smoking abruptly on the quit date. However, more recent studies suggest that among smokers who plan to quit in the near future, quit rates are higher for patients who stop abruptly. The most recent randomized trial included 697 smokers in England and found that gradual smoking cessation (decreasing by 75 percent in the two weeks prior to quitting) was associated with decreased likelihood of abstinence at four weeks when compared with abrupt smoking cessation (39 versus 49 percent) [1].

See 'Overview of smoking cessation management in adults', section on 'Setting a quit date'.

1. Lindson-Hawley N, Banting M, West R, et al. Gradual versus abrupt smoking cessation: A randomized, controlled noninferiority trial. Ann Intern Med. 2016; 164:585.