Joyner Rachael L, Phillips Remi E, Manshaii Farid A, Davis James M
Duke Center for Smoking Cessation, Duke University School of Medicine, Durham, NC, USA.
Duke Cancer Institute, Duke University, Durham, NC, USA.
SAGE Open Med Case Rep. 2025 May 5;13:2050313X251338637. doi: 10.1177/2050313X251338637. eCollection 2025.
Nicotine replacement therapy is the primary medication used to treat tobacco dependence in hospitalized patients. Recent evidence shows that varenicline is more effective than nicotine replacement, but varenicline side effects limit its use in the hospital. Low-dose varenicline has shown similar efficacy as standard dose, but has fewer side effects and thus may be useful in hospitalized patients. We assessed the effectiveness and tolerability of low-dose varenicline (1 mg each morning or 0.5 mg twice daily; patient choice) in hospitalized adult daily smokers between July 2022 and March 2023. The primary outcome was self-reported 7-day smoking abstinence at the first outpatient visit after hospitalization. Secondary outcomes included smoking reduction and medication tolerability. Of the 15 patients assessed, 8 (53.3%) reported 7-day smoking abstinence at their first post-discharge outpatient visit (mean of 14.9 days after discharge). Mean cigarettes per day decreased from 22.0 (SD 17.4) prior to hospitalization to 3.7 (SD 6.0) after hospitalization. Low-dose varenicline was well tolerated, with 80% (12) patients reporting no adverse events and 20% (3) patients reporting mild side effects not requiring a change in medication or dose. Study outcomes support the possibility that low-dose varenicline might be an effective and well-tolerated treatment for hospitalized smokers. Results from this case series are limited by the small sample size and lack of a control arm. Findings suggest that a randomized controlled trial may be warranted to assess the efficacy and tolerability of low-dose varenicline in hospitalized patients.
尼古丁替代疗法是用于治疗住院患者烟草依赖的主要药物。最近的证据表明，伐尼克兰比尼古丁替代疗法更有效，但伐尼克兰的副作用限制了其在医院中的使用。低剂量伐尼克兰已显示出与标准剂量相似的疗效，但副作用较少，因此可能对住院患者有用。我们评估了2022年7月至2023年3月期间低剂量伐尼克兰（每天早上1毫克或每天两次，每次0.5毫克；患者选择）对住院成年每日吸烟者的有效性和耐受性。主要结局是住院后首次门诊就诊时自我报告的7天戒烟情况。次要结局包括吸烟量减少和药物耐受性。在评估的15名患者中，8名（53.3%）在出院后的首次门诊就诊时报告了7天戒烟（出院后平均14.9天）。每天平均吸烟量从住院前的22.0支（标准差17.4）降至住院后的3.7支（标准差6.0）。低剂量伐尼克兰耐受性良好，80%（12名）患者报告无不良事件，20%（3名）患者报告有轻微副作用，无需改变药物或剂量。研究结果支持低剂量伐尼克兰可能是住院吸烟者一种有效且耐受性良好的治疗方法的可能性。本病例系列的结果受样本量小和缺乏对照组的限制。研究结果表明，可能需要进行一项随机对照试验来评估低剂量伐尼克兰在住院患者中的疗效和耐受性。
