Pharmacotherapies for smoking cessation in the elderly

by Kathleen Zanlocki RN

Every year in the U.S. over 392,000 people die from tobacco caused diseases, making it the leading cause of preventable death. Another 50,000 people die from exposure to secondhand smoke ("Stop smoking," 2011). The most common causes for smoking related mortality in patients over age 60 are lung cancer, cardiovascular disease, and chronic obstructive pulmonary disease (Mauk, 2010). Today’s elderly population grew into adulthood when smoking was socially acceptable by most adults and even some teenagers (Elhassan & Chow, 2007). Smoking was allowed in physician offices and even hospitals, and until 1969 elderly patients in nursing homes were still being given free cigarettes on the annual “respect for the aged” holiday (Elhassan & Chow, 2007). However, awareness of the addictive properties of tobacco spead, and smoking cessation became a recognized public health effort as more research data and evidence accumulated. (Elhassan & Chow, 2007).
The use of pharmacotherapy can be a key part of various methods used in assisting patients with their tobacco dependence (Mauk, 2010). According to the FDA, there are 2 first-line therapies used to treat withdrawal symptoms from smoking cessation; Wellbutrin XL and nicotine replacement therapy (Fiore, Jaen & Baker, 2009). Nicotine replacement therapy is the most widely used form of pharmacotherapy for managing nicotine dependence and withdrawal. These therapies include the transdermal patch, nasal spray, gum, lozenges, and nicotine inhalers. All have been shown to be effective in comparison with placebo (Fiore, Jaen & Baker, 2009). Wellbutrin XL is an antidepressant unrelated to selective serotonin reuptake inhibitors or tricyclic antidepressants. This drug’s mechanism of action related to smoking cessation is unknown. Side effects may include insomnia and loss of appetite (Fiore, Jaen & Baker, 2009). Second-line pharmacotherapies that are not approved for use for smoking cessation by the FDA are: clonidine and nortriptyline. The side effects of clonidine may include hypotension, rebound hypertension, dizziness, constipation, and agitation. The side effects of nortriptyline may include a risk of arrythmias (Fiore, Jaen & Baker, 2009).

All of these therapies may or may not be effective, but the first step in treating tobacco dependence is the patient's willingness to quit(Mauk, 2010).

References

Elhassan, A., & Chow, R. (2007). Smoking cessation in the elderly. Clinical Geriatrics, 15(2), 38-45. Retrieved from http://www.sbggpr.org.br/artigos/Como on 10/28/2011.
American Lung Association, (2011). Stop smoking. Retrieved from http://www.lungusa.org/stop-smoking
Fiore, M. C., Jaen, C. R., & Baker, T. B. US Department of Health and Human Services, Office of the Surgeon General. (2009). Treating tobacco use and dependence: 2008 update. Retrieved from http://www.surgeongeneral.gov/tobacco/tobaqrg2.htm
Mauk, K. L. (2010). Gerontological Nursing (2nd Ed.). Valpraraiso, Indiana: Jones and Bartlett Publishers.

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.