1. Treating Tobacco Dependence Stacy Seikel, MD Board Certified Addiction Medicine Board Certified Anesthesiology

6. Cigarette smoking is the chief avoidable cause of death in our society

9. Cigarette Smoking is NOT a Habit

10. What Is Tobacco Dependence? It Is a CHRONIC MEDICAL DISEASE.

41. Orbach et al (2006) Drug Metabolism and Distribution http://dmd.aspetjournals.org/cgi/content/abstract/34/1/121 T ½ excretion = 17 ± 3 hours

43. Foulds (2006) J Clin Pract 60: 571–576

44. N N = Nicotine

45. N

46. N Na+

47. N V V = Varenicline N = Nicotine

48. N V V = Varenicline N = Nicotine

49. N V

50. N V

51. N V

52. N V

53. N V

54. N V

55. N V Na+

59. Varenicline-adverse effects Gonzales. JAMA 296:47-55 Nausea Dreams Insomnia Varenicline 28% 10% 14% Bupropion 12.5% 5.5% 22% Placebo 8.4% 5.5% 12.8%

60. Varenicline-study drug discontinuation due to adverse effects Gonzales. JAMA 296:47-55 Nausea All causes Varenicline 2.6% 8.6% Bupropion 1.8% 15.2% Placebo 0.3% 9.0%

62. Varenicline-discontinuation due to adverse effects, 1 year Williams. 23:793-801 Varenicline Placebo Adverse effects 26% 10% Lack of efficacy 0 5% Protocol deviations 2% 3% Lost to f/u 10% 15% Refusal to continue study 5% 16% All causes 46% 53%

63. Varenicline-adverse effects Williams. 23:793-801 Varenicline Placebo Nausea 40% 8% Dreams 23% 7% Insomnia 19% 9.5% Disgeusia 11% 2% Dizziness 8% 5% Any adverse effect 96% 83%

64. Varenicline-cessation Williams. 23:793-801 Varenicline Placebo Abstinence at week 52 37% 8%

71. Thank you.