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Pharmacology · single question

A patient taking fluoxetine (Prozac) for depression asks whether that medication will help her stop smoking. What is the correct response?

  1. Fluoxetine is first-line therapy for nicotine dependence
  2. Fluoxetine doubles quit rates and should be continued for this purpose
  3. Fluoxetine has no established efficacy for smoking cessation
  4. Fluoxetine must be stopped before any cessation attempt
Show answer and explanation

Correct answer: C. Fluoxetine has no established efficacy for smoking cessation

  • A. First-line pharmacotherapy is varenicline, bupropion SR, or nicotine replacement therapy.
  • B. This describes bupropion, not fluoxetine. The two are both antidepressants but are not interchangeable for this indication.
  • C. CORRECT. Fluoxetine is an SSRI and has NOT been shown to improve cessation outcomes. The antidepressant with proven efficacy is BUPROPION SR, which acts as a dopamine/noradrenaline reuptake inhibitor and a nicotinic receptor antagonist — a different mechanism entirely. Nortriptyline has second-line evidence. SSRIs as a class do not.
  • D. There is no reason to stop an effective antidepressant. Untreated depression makes a quit attempt harder, not easier.

Note: Approved first-line agents: varenicline (partial α4β2 agonist, the most effective single agent), bupropion SR, and the five NRT formulations — patch, gum, lozenge, inhaler, nasal spray. Bupropion is contraindicated in seizure disorders and eating disorders.

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