Methods for smoking cessation and treatment of nicotine dependence.
Smoking is related to 30% of cancer deaths. It is a risk factor for respiratory tract, esophagus, stomach, pancreas, uterine cervix, kidney and bladder carcinomas. Nicotine induces tolerance and addiction by acting on the central dopaminergic pathways, thus leading to pleasure and reward sensations within the limbic system. It stimulates the central nervous system (CNS), enhances alertness and reduces the appetite. A 50% reduction of nicotine consumption may trigger withdrawal symptoms in addicted individuals: anxiety, anger, sleep disorders, hunger, cognitive dysfunction and cigarette craving. Medical advice is the cornerstone of smoking cessation. Pharmacotherapy of nicotine addiction comprises first-line (bupropion and nicotine replacement therapy) and second-line (clonidine and nortriptyline) drugs. Bupropion is a non-tricyclic antidepressant that inhibits dopamine uptake, whose contraindications are: epilepsy, eating disorders, uncontrolled hypertension, recent alcohol abstinence and current therapy with MAO inhibitors. Nicotine replacement therapy can be done with patches or gums. Counseling groups and behavioral interventions are efficacious. The effects of acupuncture on smoking cessation are not fully elucidated. Prompt smoking cessation or gradual reduction strategies have similar success rates.
Balbani
Aracy Pereira Silveira
AP
Discipline of Otorhinolaryngology and Head and Neck Surgery, Medical School Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, UNESP. a_balbani@hotmail.com
Montovani
Jair Cortez
JC
D026881:Acupuncture; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D000928:Antidepressive Agents / Q000008:administration & dosage; D016642:Bupropion / Q000008:administration & dosage; D003000:Clonidine / Q000008:administration & dosage; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D009538:Nicotine / Q000008:administration & dosage; D018722:Nicotinic Agonists / Q000008:administration & dosage; D009661:Nortriptyline / Q000008:administration & dosage; D012907:Smoking / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000523:psychology
D000316:Adrenergic alpha-Agonists; D000928:Antidepressive Agents; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine; D009661:Nortriptyline; D003000:Clonidine