➤ For tobacco-dependent adults in whom treatment is being
initiated, we suggest varenicline over electronic cigarettes
(conditional recommendation, very low certainty in the
estimated effects).
Remarks: The recommendation's strength reflects very low certainty in the effects
used to derive the recommendation. After our evidence synthesis, new evidence
emerged regarding serious adverse effects of electronic cigarettes. If these serious
adverse effects continue to be reported, the strength of the recommendation
should be reevaluated. Note that this recommendation is intended for treatment
of tobacco dependence under the supervision of a clinician; it should not be
extrapolated to unsupervised treatment or recreational use.
➤ In tobacco-dependent adults who are not ready to
discontinue tobacco use, we recommend that clinicians
begin treatment with varenicline rather than waiting
until patients are ready to stop tobacco use (strong
recommendation, moderate certainty in the estimated
effects).
➤ For tobacco-dependent adults with comorbid psychiatric
conditions, including substance-use disorder, depression,
anxiety, schizophrenia, and/or bipolar disorder, for whom
treatment is being initiated, we recommend varenicline
over a nicotine patch (strong recommendation, moderate
certainty in the estimated effects).
➤ For tobacco-dependent adults for whom treatment is being
initiated with a controller, we recommend using extended-
duration (>12 wk) over standard-duration (6–12 wk)
therapy (strong recommendation, moderate certainty in the
estimated effects).
