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Heavy Smokers, Smoking Cessation, and Clonidine-Reply

Alexander H. Glassman, MD; Lirio Covey, PhD; Fay Stetner, MS, MPA; B. Timothy Walsh, MD; Pamela Raizman, MSW
JAMA. 1988;260(11):1553. doi:10.1001/jama.1988.03410110060018.
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In Reply.—  We are pleased to hear of Dr Green's use of the transdermal clonidine patch in smoking cessation. We are also aware of an article by Appel1 suggesting that the transdermal patch is effective. Cigarette craving during smoking withdrawal is known to show diurnal variation.2 Individual pills give a flexibility to dosing over the day that we suspect may give the pill an advantage over the patch. If one clonidine preparation actually had an advantage, this would obviously need to be tested.Dr Cox asks for clarification of several issues that we agree deserve clarification. Our requirement that smokers cut down a minimum of 50% by quit day to be entered in the study might have distorted our sample. We used this criterion because we believed clonidine reduced withdrawal symptoms and, if a smoker did not cut down his cigarette consumption sufficiently to develop withdrawal symptoms, the


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