Prescription Treatment Options for Individuals With Tobacco Use Disorder

43-year-old male, KP, presents for follow-up in clinic.

PMH: hyperlipidemia, coronary artery disease, obesity class 1, tobacco use disorder

Allergies: NKDA

SH: Costco store manager. Smokes 1.5 ppd x 20 years. Has first cigarette within 10 minutes of waking up. Denies illicit drug use. Consumes 2-3 beers on the weekends.


  1. Aspirin 81 mg – 1 tablet PO daily for heart.
  2. Varenicline 1 mg – 1 tablet PO twice a day x 11 weeks for smoking cessation.
  3. Rosuvastatin 20 mg – 1 tablet PO daily for cholesterol.

Vitals: BP- 118/76, HR- 75 bpm, BMI: 31 kg/m2
Labs: WNL

During the clinic appointment, KP mentioned that he no longer wants to take varenicline due to the increased frequency of "weird dreams." The dreams are usually violent and fear-provoking and usually occur about 3-4 nights out of the week. The patient states that he started having the dreams a couple of days after starting therapy. He mentioned that the dreams kept occurring and became more intense to the point of him stopping varenicline all together and restarting cigarettes. The patient states that he is still willing to quit and is aware of the benefits of quitting. He mentions that he prefers a daily pill that he can administer with his other medications.

Which of the following pharmacological treatment options is preferred according to the American College of Cardiology (ACC) 2018 Expert Consensus Decision Pathway on Tobacco Cessation Treatment?

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