Pharmacological treatments for tobacco dependence

Abstract

There are currently three licensed therapies for smoking cessation: nicotine replacement (NR), bupropion and varenicline.NR can be indicated for: 1) aid in abrupt cessation; 2) gradual reduction in order to quit smoking; 3) temporary abstinence; and 4) smoking reduction maintenance. A meta-analysis has found that the relative risk of abstinence for any form of NR relative to control was 1.6. It has been found that starting NR treatment 1-3 weeks before smoking cessation and combining NR products, usually patch and gum, increases efficacy. Recently some new nicotine administration forms, i.e. lozenge, mouth spray and a pouch, have been developed. They seem to have the potential to relieve cravings faster than the current high-dose gum, and also be more preferred.Varenicline is a selective partial agonist at the a 4 b 2 nicotinic acetylcholine receptors (nAChR). It decreases cravings and alleviates the symptoms of withdrawal. It can also reduce the rewarding and reinforcing effects of nicotine. Trials have shown varenicline to have increased efficacy relative to bupropion. Varenicline has also been compared with NR (21 mg transdermal patch) in one randomised study. Abstinence at the end of treatment at 12 weeks was significantly increased for varenicline (56%) compared with for nicotine patch (43%). Some post-marketing reports have expressed concern about psychiatric adverse effects, such as aggression, depression and suicides. The European Medicines Agency and the Food and Drug Administration of the USA are monitoring reported side-effects, but so far no confirmed casual relationship between these adverse effects and varenicline has been established.Bupropion inhibits neuronal re-uptake of dopamine and norepinephrine and is an antagonist on the nAChR. Its efficacy, compared with placebo, has been proved in several meta-analyses. A recent study suggests that longer pre-cessation use of bupropion, e.g. for 4 weeks, can improve efficacy results.Under development for the treatment of tobacco dependence are cannabinoid antagonists, immunotherapy against nicotine, monoaminooxidase inhibitors, dopamine receptor D3 receptor antagonists and partial agonists, glutamatergic and GABA-ergic compounds and novel selective nicotine cholinergic receptor agonists and antagonists.

Calculating gambling odds and lung ages for smokers

“…This should elicit a response and open discussion regarding the dangers of continuing cigarette smoking. Referral to support groups, educational and counselling sessions, and the use of newer pharmaceuticals all offer avenues for success [8,9,20,29,30].…”

“…Increasing cigarette taxes, reducing locations where smoking is allowed, litigating, advertising the effects of tobacco smoking and increasing the stigma of smoking have all been helpful [6,7]. Health practitioners have assisted their patients by listening, counselling, referring to support groups and prescribing drugs to mollify withdrawal effects from nicotine [8][9][10]. However, spirometry has usually been of minimal benefit [11][12][13], perhaps because results are not presented optimally.…”

Pharmacological Intervention of Nicotine Dependence

“…The most common indication for NRT is to aid the patients in abrupt cessation, but additional uses are also licensed in some countries, such as gradual reduction to quit; temporary abstinence, that is, for short periods of abstinence where smoking is not allowed; and maintenance of reduction [ 12 ]. NRT has also been investigated as an aid in reduction of habit size of nicotine use among smokers not willing to quit.…”

“…NRT has also been investigated as an aid in reduction of habit size of nicotine use among smokers not willing to quit. In 2 meta-analyses, it was found that for smokers who are unwilling to stop smoking completely but want to reduce their habit size the use of NR compared with placebo increased the likelihood that they would make a cessation attempt and that they succeeded more often with the cessation [ 4 , 12 ].…”

Smoking cessation: a clinical update

“…In the third chapter, CORNUZ and WILLI [3] describe nonpharmacological smoking cessation interventions in clinical practice, such as specific counselling to inform and sensitise the smoker and to motivate and support them to quit smoking. The next chapter deals with the specific pharmacological treatments to help in smoking cessation, and in this chapter FAGERSTRÖ M and JIMÉ NEZ-RUIZ [4] describe the role of nicotine replacement therapy on the one hand, and of bupropion and varenicline on the other. In the fifth chapter, WEST and STAPLETON [5] describe the clinical and public health significance of treatments to aid smoking cessation, and in the final chapter the implications and priorities for tobacco control in Belgium and Europe are discussed by BARTSCH [6].…”