A patient taking FLUOXETINE for depression asks about quitting smoking. All of the following statements are accurate EXCEPT:

Correct answer: A. His current medication will help him quit smoking

• A. CORRECT — this is the EXCEPTION. FLUOXETINE is an SSRI indicated for depression. It has NO established efficacy for smoking cessation. The antidepressant that does have that indication is BUPROPION, a norepinephrine–dopamine reuptake inhibitor marketed as Zyban for this purpose — a different drug with a different mechanism.
• B. This IS accurate. Combining serotonergic agents raises the risk of SEROTONIN SYNDROME — agitation, hyperthermia, clonus, hyperreflexia and autonomic instability. Relevant to dentistry because tramadol is serotonergic and should be avoided in a patient on an SSRI.
• C. This IS accurate. BUPROPION and VARENICLINE are both first-line pharmacotherapies for smoking cessation, with varenicline generally the most effective single agent.
• D. This IS accurate. Nicotine replacement is compatible with SSRI therapy and is frequently combined with bupropion for additive benefit.

Note: ⚑ The contributor warned that this item circulates both with and without the word EXCEPT — read the stem twice. Two further dental points on SSRIs: they increase bleeding tendency through impaired platelet serotonin uptake, and they commonly cause xerostomia with its attendant caries risk.