Table 1
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Multidisciplinary approach for smoking cessation strategies after KT

Psychosocial counseling
Sources of counselors

  • Physicians/provider brief advice sessions during office visits

  • Telephone quit lines

  • Individual counseling

  • Group counseling

  • Computer program or Internet counseling

Pharmacologic interventions
First-line pharmacotherapyMechanism of actionClinical use
Nicotine replacement therapy

  • Stimulates nicotinic receptors in the ventral tegmental area

First line for pharmacologic intervention

  • Nicotine gum

  • Nicotine inhaler

  • Nicotine lozenge

  • Nicotine nasal spray

  • Nicotine patch

Sustained-release bupropion

  • Acts via dopamine and norepinephrine reuptake inhibitors

  • Consider in patients with a prior history of depression

  • Contraindications: alcohol abuse, previous seizures and history of head trauma, stroke, brain injury (bupropion decreases the seizure threshold), history of eating disorders

  • High seizure risk if used concomitantly with cyclosporine.

Varenicline

  • Partial agonist/antagonist at the α-4 β-2 nicotine receptor

Renally excreted, needs dose adjustment in patients with impaired renal function
Second-line pharmacotherapy
NortriptylineNoradrenergic actions substituting for the noradrenergic actions of nicotine receptor antagonist

  • Consider in patients with a prior history of depression

Clonidineα-2-adrenergic receptor agonistSide effects including dry mouth and sedation is higher in the therapy group in a dose-dependent fashion
Psychosocial counseling
Sources of counselors

  • Physicians/provider brief advice sessions during office visits

  • Telephone quit lines

  • Individual counseling

  • Group counseling

  • Computer program or Internet counseling

Pharmacologic interventions
First-line pharmacotherapyMechanism of actionClinical use
Nicotine replacement therapy

  • Stimulates nicotinic receptors in the ventral tegmental area

First line for pharmacologic intervention

  • Nicotine gum

  • Nicotine inhaler

  • Nicotine lozenge

  • Nicotine nasal spray

  • Nicotine patch

Sustained-release bupropion

  • Acts via dopamine and norepinephrine reuptake inhibitors

  • Consider in patients with a prior history of depression

  • Contraindications: alcohol abuse, previous seizures and history of head trauma, stroke, brain injury (bupropion decreases the seizure threshold), history of eating disorders

  • High seizure risk if used concomitantly with cyclosporine.

Varenicline

  • Partial agonist/antagonist at the α-4 β-2 nicotine receptor

Renally excreted, needs dose adjustment in patients with impaired renal function
Second-line pharmacotherapy
NortriptylineNoradrenergic actions substituting for the noradrenergic actions of nicotine receptor antagonist

  • Consider in patients with a prior history of depression

Clonidineα-2-adrenergic receptor agonistSide effects including dry mouth and sedation is higher in the therapy group in a dose-dependent fashion
Table 1
Open in new tab

Multidisciplinary approach for smoking cessation strategies after KT

Psychosocial counseling
Sources of counselors

  • Physicians/provider brief advice sessions during office visits

  • Telephone quit lines

  • Individual counseling

  • Group counseling

  • Computer program or Internet counseling

Pharmacologic interventions
First-line pharmacotherapyMechanism of actionClinical use
Nicotine replacement therapy

  • Stimulates nicotinic receptors in the ventral tegmental area

First line for pharmacologic intervention

  • Nicotine gum

  • Nicotine inhaler

  • Nicotine lozenge

  • Nicotine nasal spray

  • Nicotine patch

Sustained-release bupropion

  • Acts via dopamine and norepinephrine reuptake inhibitors

  • Consider in patients with a prior history of depression

  • Contraindications: alcohol abuse, previous seizures and history of head trauma, stroke, brain injury (bupropion decreases the seizure threshold), history of eating disorders

  • High seizure risk if used concomitantly with cyclosporine.

Varenicline

  • Partial agonist/antagonist at the α-4 β-2 nicotine receptor

Renally excreted, needs dose adjustment in patients with impaired renal function
Second-line pharmacotherapy
NortriptylineNoradrenergic actions substituting for the noradrenergic actions of nicotine receptor antagonist

  • Consider in patients with a prior history of depression

Clonidineα-2-adrenergic receptor agonistSide effects including dry mouth and sedation is higher in the therapy group in a dose-dependent fashion
Psychosocial counseling
Sources of counselors

  • Physicians/provider brief advice sessions during office visits

  • Telephone quit lines

  • Individual counseling

  • Group counseling

  • Computer program or Internet counseling

Pharmacologic interventions
First-line pharmacotherapyMechanism of actionClinical use
Nicotine replacement therapy

  • Stimulates nicotinic receptors in the ventral tegmental area

First line for pharmacologic intervention

  • Nicotine gum

  • Nicotine inhaler

  • Nicotine lozenge

  • Nicotine nasal spray

  • Nicotine patch

Sustained-release bupropion

  • Acts via dopamine and norepinephrine reuptake inhibitors

  • Consider in patients with a prior history of depression

  • Contraindications: alcohol abuse, previous seizures and history of head trauma, stroke, brain injury (bupropion decreases the seizure threshold), history of eating disorders

  • High seizure risk if used concomitantly with cyclosporine.

Varenicline

  • Partial agonist/antagonist at the α-4 β-2 nicotine receptor

Renally excreted, needs dose adjustment in patients with impaired renal function
Second-line pharmacotherapy
NortriptylineNoradrenergic actions substituting for the noradrenergic actions of nicotine receptor antagonist

  • Consider in patients with a prior history of depression

Clonidineα-2-adrenergic receptor agonistSide effects including dry mouth and sedation is higher in the therapy group in a dose-dependent fashion
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