Nicotine receptor partial agonists for smoking cessation

Abstract

BACKGROUND: Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). OBJECTIVES:The primary objective of this review is to assess the efficacy and tolerability of nicotine receptor partial agonists, including cytisine, dianicline and varenicline for smoking cessation. SEARCH METHODS:We searched the Cochrane Tobacco Addiction Group's specialised register for trials, using the terms ('cytisine' or 'Tabex' or 'dianicline' or 'varenicline' or 'nicotine receptor partial agonist') in the title or abstract, or as keywords. The register is compiled from searches of MEDLINE, EMBASE, PsycINFO and Web of Science using MeSH terms and free text to identify controlled trials of interventions for smoking cessation and prevention. We contacted authors of trial reports for additional information where necessary. The latest update of the specialized register was in December 2011. We also searched online clinical trials registers. SELECTION CRITERIA: We included randomized controlled trials which compared the treatment drug with placebo. We also included comparisons with bupropion and nicotine patches where available. We excluded trials which did not report a minimum follow-up period of six months from start of treatment. DATA COLLECTION AND ANALYSIS:We extracted data on the type of participants, the dose and duration of treatment, the outcome measures, the randomization procedure, concealment of allocation, and completeness of follow-up. The main outcome measured was abstinence from smoking at longest follow-up. We used the most rigorous definition of abstinence, and preferred biochemically validated rates where they were reported. Where appropriate we pooled risk ratios (RRs), using the Mantel-Haenszel fixed-effect model. MAIN RESULTS: Two recent cytisine trials (937 people) found that more participants taking cytisine stopped smoking compared with placebo at longest follow-up, with a pooled RR of 3.98 (95% confidence interval (CI) 2.01 to 7.87). One trial of dianicline (602 people) failed to find evidence that it was effective (RR 1.20, 95% CI 0.82 to 1.75). Fifteen trials compared varenicline with placebo for smoking cessation; three of these also included a bupropion treatment arm. We also found one open-label trial comparing varenicline plus counselling with counselling alone. We found one relapse prevention trial, comparing varenicline with placebo, and two open-label trials comparing varenicline with nicotine replacement therapy (NRT). We also included one trial in which all the participants were given varenicline, but received behavioural support either online or by phone calls, or by both methods. This trial is not included in the analyses, but contributes to the data on safety and tolerability. The included studies covered 12,223 participants, 8100 of whom used varenicline. The pooled RR for continuous or sustained abstinence a...

Use of Varenicline for 4 Weeks Before Quitting Smoking

“…T HE ␣4␤2 NICOTINIC RECEPtor partial agonist varenicline tartrate is an effective smoking cessation medication. 1,2 It is used in dosages increasing from 0.5 to 1 mg/d for 1 week before the target quit date (TQD) to generate sufficient systemic levels and to habituate users to the possible occurrence of nausea and thereafter in dosages of 2 mg/d for up to 6 months.…”

Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST – 2021

“…[413][414][415][416] A vareniclina duplicou as taxas de abstinência em relação ao placebo (RR: 2,24; IC 95%: 2,06 a 2,43). 417 Estudo envolvendo mais de 8.000 fumantes comparou o uso de vareniclina, bupropiona, adesivos de nicotina e placebo, randomizados na razão de 1:1:1:1, e encontrou maior taxa de abstinência do grupo vareniclina, em 6 meses, do que todos nos outros grupos. 418 Em um estudo randomizado em pacientes com coronariopatia crônica, o uso de vareniclina mostrou aumento da chance de abstinência contínua em 1 ano, em comparação com o placebo (OR: 3,14; IC 95%: 1,94 a 5,11).…”

Galantamine as a Treatment Option for Nicotine Addiction

“…It can be prescribed for another 12 weeks to prevent relapse. However, limited evidence suggests that varenicline can contribute to relapse prevention [15]. As far as galantamine is concerned, it is generally prescribed lifelong as a cognitive enhancer in dementia.…”