Managing nicotine addiction.
Nicotine addiction has been identified as the primary contributor to continued widespread tobacco use worldwide. Although the health benefits of smoking cessation are well publicized, few smokers successfully quit on a long-term basis. A number of pharmacological agents have been shown to approximately double long-term smoking cessation rates and have, therefore, been recommended as first-line therapy for the treatment of nicotine dependence in the clinical practice guidelines recently released by the Agency for Healthcare Research and Quality (AHRQ). These include the currently available dosage forms of nicotine replacement therapy (gum, patch, nasal spray, and inhaler) and bupropion. Other agents that have exhibited some efficacy in increasing smoking cessation rates are nortriptyline and clonidine. All pharmacological treatments are most effective in conjunction with behavioral therapy. Other approaches to treating tobacco use disorder now being investigated include additional ways to administer nicotine, a vaccine to prevent nicotine from crossing the blood-brain barrier, and agents that alter the metabolism of nicotine. This review summarizes the characteristics of nicotine addiction, reviews the pharmacological agents currently used to treat tobacco use disorder, and describes possible approaches to treat nicotine dependence in the future.
Kotlyar
Michael
M
Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota at Twin Cities, Minneapolis 55455, USA. kotly001@umn.edu
Hatsukami
Dorothy K
DK
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D016642:Bupropion / Q000627:therapeutic use; D002638:Chewing Gum; D003000:Clonidine / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D016015:Logistic Models; D009538:Nicotine / Q000008:administration & dosage*; D018722:Nicotinic Agonists / Q000008:administration & dosage*; D009661:Nortriptyline / Q000627:therapeutic use; D011247:Pregnancy; D012907:Smoking / Q000188:drug therapy*; D013565:Sympatholytics / Q000627:therapeutic use; D020340:Tobacco Use Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000188:drug therapy*; D014481:United States; D016270:United States Agency for Healthcare Research and Quality; D016387:Women's Health
D000929:Antidepressive Agents, Tricyclic; D002638:Chewing Gum; D004338:Drug Combinations; D018722:Nicotinic Agonists; D013565:Sympatholytics; D016642:Bupropion; D009538:Nicotine; D009661:Nortriptyline; D003000:Clonidine