Pharmacotherapy: Nicotine Replacement Therapy and Other Drugs in Smoking Cessation (Including Vaccination)

Abstract

The basic principles in quitting smoking are to set a target quit day and try to cut down to zero cigarettes in a few weeks -but best at target quit day -and then use one of the primary drugs for smoking cessation for 2-3 months. In this period, the ex-smoker has to break the psychological addiction as well as the nicotine dependence. Using one of the primary drugs reduces the withdrawal symptoms. Any support will increase quit rate and counselling should be used in combination with one of the primary drugs, i.e. varenicline, nicotine replacement treatment (NRT) and bupropion SR. Varenicline and the combination of two NRT formulations is equally effective, while varenicline is more effective than either single NRT or bupropion SR. NRTs are especially safe. All three drugs have also been shown to be especially effective in patients with chronic obstructive pulmonary disease and in patients with cardiovascular disorders; the main reason for the larger effect in this subgroup is the low quit rate among placebo-treated subjects. There is extensive and solid scientific proof that underlines the efficacy of these three primary drugs in smoking cessation as well as the very high cost-effectiveness of smoking cessation. Vaccines against nicotine have not been effective until now. © 2015 S. Karger AG, BaselThe aims of this chapter are to summarise the state of the art in smoking cessation with the three first-line drugs, i.e. nicotine replacement therapy (NRT), varenicline and bupropion SR, as well as a short review of the second-line drugs and also the present state of nicotine vaccination. Special focus will be on NRT as NRT is the most used approach for smoking cessation. After reading this chapter, the clinician should have the necessary background information to be able to use and select among the three primary drugs in smoking cessation. Benefits of Smoking CessationLong-term smoking is the main causal reason for chronic obstructive pulmonary disease (COPD) and lung cancer, and to approximately one third of cases of cardiovascular disorders. Compared to never smokers, long-term daily cigarette smoking is associated with higher early mortality from smokinginduced diseases, and ex-smokers have a longer average survival than continuing smokers [1] (see also chapters 7 and 8). Particularly convincing evidence comes from a longitudinal study of UK male doctors who were followed for more than 50 years [1,2]. It was found that the mortality of the smokers was almost double (1.8 times) that of never smokers and that COPD was approximately 13 times more prevalent and lung cancer approximately15 times more prevalent among smokers compared with never smokers. After a 50-year observation, it was concluded that smokers die 10 years younger than non-smokers. Cessation at ages 60, 50, 40 or 30 years gains about 3, 6, 9 or 10 years of life expectancy, respectively. Among UK women, two thirds of all deaths of smokers in their 50s, 60s and 70s are caused by smoking; smokers lose at least 10 years of lifespan [3]. Smoking is also a st...