One in three adults in India uses tobacco, a highly addictive substance in one 
or other form. In addition to prevention of tobacco use, offering evidence-based 
cessation services to dependent tobacco users constitutes an important approach 
in addressing this serious public health problem. A combination of behavioral 
methods and pharmacotherapy has shown the most optimal results in tobacco 
dependence treatment. Among currently available pharmacological agents, drugs 
that preferentially act on the α4 β2-nicotinic acetyl choline receptor like 
varenicline and cytisine appear to have relatively better cessation outcomes. 
These drugs are in general well tolerated and have minimal drug interactions. 
The odds of quitting tobacco use are at the very least doubled with the use of 
partial agonists compared with placebo and the outcomes are also superior when 
compared to nicotine replacement therapy and bupropion. The poor availability of 
partial agonists and specifically the cost of varenicline, as well as the lack 
of safety data for cytisine has limited their use world over, particularly in 
developing countries. Evidence for the benefit of partial agonists is more 
robust for smoking rather than smokeless forms of tobacco. Although more studies 
are needed to demonstrate their effectiveness in different populations of 
tobacco users, present literature supports the use of partial agonists in 
addition to behavioral methods for optimal outcome in tobacco dependence.