Comparison of Fixed‐Dose Transdermal Nicotine, Tapered‐Dose Transdermal Nicotine, and Buspirone in Smoking Cessation

Abstract

The authors compared the outcome of 208 smokers treated with fixed-dose transdermal nicotine (n = 69), tapered-dose transdermal nicotine (n = 71), or buspirone (n = 68). At baseline, there were no significant differences among the three treatment groups with regard to age, gender, educational level, duration of smoking, number of cigarettes smoked per day, concomitant disease states or drug use, or Fagerstrom score. All smokers participated in a behavior modification program. Fixed-dose transdermal nicotine was given at a dose of 21 or 22 mg/day for 6 weeks. Tapered-dose transdermal nicotine was given at a dose of 21 or 22 mg/day for 4 weeks, 14 mg/day for 4 weeks and 7 mg/day for 4 weeks. Both transdermal nicotine regimens were initiated on the evening before the attempted quit date. Buspirone was started 21 days before the quit attempt and continued for 7 days after the quit attempt. Buspirone was initiated at 5 mg TID for 7 days and then 10 mg TID for 21 days. Smoking cessation was assessed by patient diaries and random plasma thiocyanate determinations. Dropouts for any reason were considered treatment failures. Quit rates were as shown in the Table I. Discontinuation of treatment for perceived side effects and dropouts for all reasons were not significantly different among the treatment groups. The authors conclude that fixed-dose transdermal nicotine, tapered-dose transdermal nicotine, and buspirone are associated with similar efficacy and safety when combined with behavior modification in smoking cessation.

Adverse events associated with nicotine replacement therapy (NRT) for smoking cessation. A systematic review and meta-analysis of one hundred and twenty studies involving 177,390 individuals

“…Additional file 1 and Table 1 provide study characteristics. Ninety-two studies[26-117] were RCTs involving 32,185 participants and 28[56,75,93,110,118-141] were considered as observational studies involving 145, 205 participants.…”

New mechanisms and perspectives in nicotine withdrawal

“…Serotonin (5-hydroxytryptamine; 5-HT) is associated with appetitive behavior and affective state, and previous studies support a role for 5-HT activation in aspects of the nicotine withdrawal syndrome, including CPA (Suzuki et al 1997) and anxiety-like responses (West et al 1991; Hilleman et al 1992; Hilleman et al 1994). More recently, 5-HT 2C receptor agonists and a 5-HT 2A antagonist were shown to block nicotine withdrawal-induced increases in immobility in rats subjected to the forced swim test, implicating the serotonergic system in the depressive-like effects of nicotine withdrawal (Zaniewska et al 2010).…”

Effects of Chronic Buspirone Treatment on Nicotine and Concurrent Nicotine+Cocaine Self-Administration

“…Clinical studies of buspirone's effects on cigarette smoking in non-cocaine users have been inconsistent. Some reports indicate that buspirone significantly increased abstinence from cigarette smoking (Hilleman et al, 1992(Hilleman et al, , 1994, but other studies found no significant effect of buspirone on smoking cessation and nicotine withdrawal symptoms (Farid and Abate, 1998;Schneider et al, 1996). Buspirone was most effective as a smoking cessation aid in high-anxiety smokers (Cinciripini et al, 1995).…”