What is the recommended treatment regimen for a patient who smokes 1.5 packs per day and is seeking cessation?

The recommended treatment regimen for a patient who smokes 1.5 packs per day and is seeking cessation is the use of varenicline at a dose of 1 mg twice daily, starting one week before their quit date.

Varenicline is a partial agonist at the nicotinic acetylcholine receptor, which helps to reduce withdrawal symptoms and cravings by stimulating the receptor while simultaneously blocking nicotine from attaching to it. Starting treatment a week before quitting allows the medication to build up in the system, which can help ease the transition and increase the chances of successful cessation. This approach is particularly important for heavy smokers, as it achieves more stable levels of the drug in the body to effectively manage cravings and withdrawal symptoms.

In contrast, alternative options like nicotine nasal spray and lozenges may not provide the same sustained benefit as varenicline for a heavy smoker due to their shorter action and need for more frequent dosing. Additionally, the nicotine patch dose suggested may be insufficient for someone smoking 1.5 packs per day, leading to inadequate management of withdrawal symptoms and cravings. Therefore, starting varenicline as recommended is the most effective strategy for this patient.