June 2024 Journal Club – When Quitting Fails the First Time: Why It’s Time to Rethink Nicotine Cessation Dosing

What do you do when your patient who wants to quit nicotine accepts a prescription for NRT or varenicline and comes back in 6 weeks still smoking? Do you keep them on the same medication with a few behavioral tweaks? Do you add medication? Or something else? This study –punchline approaching — suggests you switch them to varenicline if they are using NRT, or increase the dose of current therapy (if it is NRT or varenicline). Hallelujah – it is wonderful to have a novel approach, as well as evidence that is beyond that first step of treatment. The concept of dosing to effect is consistent with lessons learned over the years of treating OUD -and from that, we know that the dose of the blockade/replacement can make all the difference.