ABC | Volume 112, Nº4, April 2019

FSCLP Statement Oliveira et al 2019: Recommendations for reducing tobacco consumption in Portuguese-Speaking countries Arq Bras Cardiol. 2019; 112(4):477-486 Table 12 – Non-nicotine replacement therapy (NNRT) Bupropion hydrochloride • Simulates some of the effects of nicotine in the brain, blocking neuronal uptake of dopamine and norepinephrine. May be used in combination with nicotine replacement therapy with patch. • Excellent choice for subgroups of smokers who are more prone to relapse, those with depression after smoking cessation, for women, and for those with a high degree of addiction. Success cessation rates are 30% to 36%. • Therapeutic regimen: Start treatment 8 days before smoking cessation. - 150 mg in the morning for 3 days, followed by 150 mg in the morning and afternoon with 8-hour intervals for 3 months; may be increased for up to 6 months. Control blood pressure; if blood pressure increases, the dose may be reduced to 150 mg/day before discontinuation in refractory cases. Reduce doses in renal and hepatic failure to 150 mg/day. Monoamine oxidase inhibitors should be suspended 15 days before starting bupropion. Use with caution or avoid in patients taking antipsychotics, theophylline, and systemic steroids, as it predisposes to the occurrence of seizures. • Contraindications: – Absolute: history of seizure (including febrile seizure), epilepsy, traumatic brain injury, electroencephalographic abnormalities, brain tumor, severe alcoholism, anorexia nervosa and bulimia, pregnancy, and lactation. – Relative: Concomitant use of barbiturates, benzodiazepines, cimetidine, pseudoephedrine, phenytoin, oral hypoglycemic agents, or insulin. Varenicline tartrate • Partial agonist for the α4β2 nicotinic acetylcholine receptor, mediating the release of dopamine in the brain. • Double effect: reduces withdrawal symptoms and desire to smoke. • Therapeutic regimen: start 1 week before the interruption day, with 0.5 mg for 3 days in the morning; 0.5 mg from the 4th to the 7th day in the morning (7 pm) and afternoon (7 pm); and 1 mg a day for 3 months in the morning (7 am) and afternoon (7 pm). May be extended for up to 6 months if full smoking cessation is not achieved, or if there is risk of relapse. Oral administration, no hepatic metabolism, and practically in natura renal excretion. • Adverse effects: nausea (20%), headache, vivid dreams, and weight gain. Rarely, mood changes, agitation, and aggressiveness. • Because it does not undergo hepatic metabolism, varenicline does not interfere with digoxin, metformin, or warfarin used concomitantly. Cimetidine may cause increased varenicline bioavailability. • Caution is advised in patients with renal insufficiency. • Contraindication: gestation, lactation, age below 18 years, bipolar disorder, schizophrenia, or epilepsy. Table 13 – Usual pharmacological treatment for smoking Medication Start of treatment Therapeutic scheme Duration (weeks) Nicotine replacement therapy: patch On the date chosen to quit smoking 21-25 mg/day - 4 weeks 14-15 mg/day - 4 weeks 7 mg/day - 2 weeks Smokers with increased dependence may require doses greater than 21 mg 8 to 10 Nicotine replacement therapy: gum or lozenge On the date chosen to quit smoking 2 mg or 4 mg: 1 a 4/day 8 to 10 Non-nicotine replacement therapy: bupropion One week before the date chosen to quit smoking First to third day - 150 mg 1 x day Fourth day to the end - 150 mg 2 x daily 12 Non-nicotine replacement therapy: varenicline One week before the date chosen to quit smoking First to third day - 0.5 mg 1 x day Fourth to seventh day - 0.5 mg 12/12 hours Eighth day to end - 1 mg 12/12 hours 12 or limited to health services insufficient. Therefore, the World Health Organization has promoted the Framework Convention, ratified by 168 countries in 2003, 9 when the countries committed to observing certain principles that must be progressively incorporated into their laws. It is up to the health sectors of each country to remain vigilant and promote these principles with the population and political class. The following are the dates of signing of the treaty and the ratifications among PSCs: Angola (June 29, 2004 / September 20, 2007), Brazil (June 16, 2003 / November 03, 2005), Cape Verde (February 17, 2004 / October 4, 2005), Equatorial Guinea (April 1st, 2004 / November 7, 2007), Guinea-Bissau (November 7, 2008), Mozambique (June 18, 2004 / July 14, 2017), Portugal (January 9, 2004 / November 8, 2005), São Tomé and Príncipe (June 18, 2004 / April 12, 2006), and East Timor (May 25, 2004 / December 22, 2004). 24,25 Organizations specifically focused on monitoring political activities and compliance with the treaty have emerged in many countries. Like the Brazilian ACT (Non-Governmental Tobacco Control Alliance - Health Promotion - http://actbr. org.br/) , non-governmental organizations and national associations or committees exist within medical entities or in other healthcare segments interested in social mobilization, coordination, and permanent updating of control actions. 24,25 484