High-dose nicotine patch therapy. Percentage of replacement and smoking cessation

Dale, Lowell C.

doi:10.1001/jama.274.17.1353

Cited by 112 publications

(124 citation statements)

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“…However, when using the CYP2A6 phenotype (3HC/COT), the data indicate better quit rates for slow metabolizers relative to fast metabolizers on the nicotine patch (Lerman et al, submitted), as would be expected given their higher levels of nicotine. 33,55 The mean 3HC/COT ratio of the slow metabolizers was approximately 50% of that of the normal metabolizers (Figure 1). Those with a CYP2A6 intermediate metabolizer genotype, predicting approximately 75% remaining activity, were indeed intermediate and were not significantly different from either the slow or normal metabolizers.…”

Section: Discussionmentioning

confidence: 98%

“…This is important to study as increasing the amount of nicotine replaced by NRT has been shown to improve abstinence rates and alleviate withdrawal symptoms, particularly on the nicotine patch. 33,34 We investigated four CYP2A6 genetic variants, CYP2A6*2, CYP2A6*4, CYP2A6*9A and CYP2A6* 12A, which are common among Caucasians, 15 and have a known detrimental impact on enzyme function. 4,11,[35][36][37] To assess whether CYP2A6 genetic variants affect enzyme activity, smoking behaviours and plasma levels from treatments, CYP2A6 activity groups were defined based on the impact of each CYP2A6 allele.…”

Section: Introductionmentioning

confidence: 99%

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Impact of CYP2A6 genotype on pretreatment smoking behaviour and nicotine levels from and usage of nicotine replacement therapy

et al. 2006

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We investigated the effect of slow metabolism of nicotine, predicted by CYP2A6 genotypes resulting in p50% activity, on baseline smoking behaviours and treatment variables in an open-label nicotine replacement therapy (NRT) clinical trial. Caucasian smokers with CYP2A6 slow vs normal metabolism had lower metabolic activity, indicated by the 3-hydroxycotinine/ cotinine ratio (0.2370.17 vs 0.4570.22, P < 0.01, respectively). CYP2A6 slow metabolizers also smoked fewer cigarettes per day compared to normal metabolizers (2077 vs 24710, respectively, P < 0.04). With nicotine patch use, slow metabolizers had higher nicotine plasma levels compared to normal metabolizers (22.874.6 vs 15.877.6 ng/ml, respectively, P = 0.02) while using the same numbers of patches/week. With nicotine spray use, where like in smoking the nicotine intake can be easily adjusted to adapt to rates of metabolism, slow metabolizers achieved similar nicotine levels compared to normal metabolizers (5.874.1 vs 8.079.1 ng/ml, P = 0.82), by using fewer doses of nicotine spray/day (4.873.6 vs 10.578.0, respectively, P < 0.02). These findings indicate that CYP2A6 genotype influences smoking behaviour in a Caucasian treatment-seeking population and that CYP2A6 genotype affects plasma levels obtained from, and usage of, NRT.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Impact of CYP2A6 genotype on pretreatment smoking behaviour and nicotine levels from and usage of nicotine replacement therapy

et al. 2006

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“…33 The DES was developed using reports describing the effects of nicotine, caffeine, and other drugs. 30,34 The scale consisted of 17 items: "Do you feel any drug effects? ", "Do you like the drug effects?…”

Section: Outcome Measuresmentioning

confidence: 99%

Caffeine's Influence on Nicotine's Effects in Nonsmokers

Blank¹,

Kleykamp²,

Jennings³

et al. 2007

am j health behav

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Objective-To determine if nicotine's effects are influenced by caffeine in nonsmoking, moderate-caffeine consuming individuals (N=20).Methods-The first 3 sessions included one of 3 randomly ordered, double-blind caffeine doses (0, 75, or 150 mg, oral [po]) and 2 single-blind nicotine gum doses (2 and 4 mg) in ascending order. The fourth session (single blind) repeated the 0 mg caffeine condition.Results-Nicotine increased heart rate and subjective ratings indicative of aversive effects, and decreased reaction times. These effects were independent of caffeine dose and reliable across sessions. Conclusions-In nonsmokers, nicotine effects are not influenced by moderate caffeine doses.Keywords nicotine; caffeine; interaction; subjective effect; cognition Nicotine and caffeine are mild psychomotor stimulants and the most widely used drugs in the United States. 1,2 Interestingly, 80-97% of nicotine users also use caffeine: 3 smokers drink more coffee than nonsmokers and self-administer more nicotine when using caffeine. 4,5 This frequent co-administration may reflect the influence of pharmacokinetics 6,7 and/or environment. 8 Also, the effects of the nicotine-caffeine combination may differ from those of either drug alone. 1,9 Individually, nicotine and caffeine increase heart rate, 10 produce stimulation and arousal, 11,12 and improve attention. 13,14 Some of these effects may be enhanced when the drugs are combined. For example, oral caffeine, but not placebo, increased the subjective and reinforcing effects of intravenous (IV) nicotine (eg, higher ratings of "stimulated" and monetary crossover point, or amount of money willing to be paid to receive drug; [N = 9] 9 ; see also [N = 12] 1 ). Also, 2 mg nicotine gum increased accuracy on a digit-recall task when administered with active, but not placebo, caffeine [N = 6]. 15 Importantly, results from these studies may be influenced by the fact that all participants were regular nicotine users. When regular nicotine users are included in studies examining nicotine effects, results can be influenced by tolerance and dependence. For instance, recent NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript nicotine exposure may result in a marked reduction of drug effect (ie, tolerance), 16 whereas dependence can produce withdrawal signs and symptoms after a period of drug abstinence. 17 Drug-induced suppression of these signs and symptoms 18 can be mistaken for a direct effect of the drug. One way to understand the direct effects of drugs is to include individuals who are not tolerant to or dependent on them. 19,20 Accordingly, there are several reports of the combined effects of nicotine and caffeine in nonnicotine users (N = 10). 21,22 However, these small-sample studies may have been underpowered. Thus, their failure to report an enhanced effect of the nicotine/caffeine combination, relative to either drug alone, may reflect a Type II error. Although including individuals with no history of caffeine use would also be valuable, this goal is vi...

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“…Second-line pharmacotherapies to consider are clonidine and nortriptyline. 63 There is also evidence that combined NRT (e.g., combination patch and gum, 63 high-dose NRT, 65 or combined bupropion and NRT 66 ) increases long-term abstinence rates. Therefore, these medication options should be considered carefully.…”

Section: Recommendations For Nicotine Dependence Treatmentmentioning

confidence: 99%

Nicotine dependence treatment for patients with cancer

Cox

Africano

Tercyak

et al. 2003

Cancer

134

118

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A semifluidized bed was proposed to allay bed plugging during the filtration of fines‐hydrocarbon suspensions. Mitigation of plugging was allowed by alternating semifluidization during capture with unconstrained fluidization for removal of deposits. Solids holdup conditions were established to prevent deposition in the fluidization section. The cyclic parameters were varied to allow efficient removal of deposits during washing. Analysis with a filtration model accounting for solids detachment in the fixed bed section revealed that the fluidization section favored growth of aggregate size entering the fixed bed. Analysis of the split ratios between fixed and fluidized bed heights revealed that the shallowest fluidization sections delayed deposition in the fixed bed. In cyclic operation, reversibility of the semifluidized bed was best recovered via gas injection during the washing stages. However, the filtration times in successive cycles shortened with increasing washing times but lengthened with increasing the washing superficial suspension velocity. © 2008 American Institute of Chemical Engineers AIChE J, 2008

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High-dose nicotine patch therapy. Percentage of replacement and smoking cessation

Cited by 112 publications

References 0 publications

Impact of CYP2A6 genotype on pretreatment smoking behaviour and nicotine levels from and usage of nicotine replacement therapy

Impact of CYP2A6 genotype on pretreatment smoking behaviour and nicotine levels from and usage of nicotine replacement therapy

Caffeine's Influence on Nicotine's Effects in Nonsmokers

Nicotine dependence treatment for patients with cancer

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