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Guidelines published in 2008 by the U.S. Public Health Service (USPHS) recommended seven first-line pharmacological options for smoking cessation but did not offer guidance regarding choice of agent. Varenicline was noted to be the most effective medication, but the U.S. FDA had just warned about psychiatric side effects; this advisory was upgraded to a boxed warning in 2009. The boxed warning was then removed in 2016 after further research demonstrated the medication's safety. The ATS's new evidence-based practice guidelines expand on the USPHS report by providing clear recommendations about selection of initial pharmacotherapy.
Varenicline is strongly recommended o…