Smoking cessation pharmacotherapy--nicotine and non-nicotine preparations.
Cigarette smokers tend to die prematurely from a number of diseases. Cigarette smoking is an important modifiable risk factor for cardiovascular morbidity and mortality. Despite the clear health benefits of smoking cessation, smokers usually find it difficult to stop and behavioral therapies often prove insufficient. Pharmacologic intervention may aid the process because of the addictive nature of nicotine. Nicotine replacement therapy, which is regarded as first-line therapy, was developed to overcome the symptoms of nicotine withdrawal that many patients find distressing. Different modes of administration include inhalation and buccal or transdermal absorption. The orally administered non-nicotine drugs varenicline and bupropion are also regarded as first-line treatments, either used alone or as an adjunct to nicotine replacement therapy. Second-line treatments include clonidine and nortriptyline. Other treatment strategies that have been examined include monoamine oxidase inhibitors and selective serotonin reuptake inhibitors; efficacy has yet to be proven definitively. A novel approach to treatment using the cannabinoid-1 receptor antagonist rimonabant is also under investigation.
Frishman
William H
WH
Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY 10595, USA. william_frishman@nymc.edu
D000279:Administration, Cutaneous; D000280:Administration, Inhalation; D001552:Benzazepines / Q000627:therapeutic use; D016642:Bupropion / Q000627:therapeutic use; D002638:Chewing Gum; D003000:Clonidine / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D009538:Nicotine / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D009661:Nortriptyline / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D011720:Pyrazoles / Q000627:therapeutic use; D011810:Quinoxalines / Q000627:therapeutic use; D011978:Receptors, Nicotinic / Q000187:drug effects*; D000077285:Rimonabant; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012907:Smoking / Q000009:adverse effects / Q000188:drug therapy / Q000378:metabolism; D016540:Smoking Cessation / Q000379:methods*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000209:etiology; D014029:Tobacco Use Disorder / Q000188:drug therapy* / Q000209:etiology; D014030:Tobacco, Smokeless; D000068580:Varenicline
D001552:Benzazepines; D016642:Bupropion; D002638:Chewing Gum; D003000:Clonidine; D008996:Monoamine Oxidase Inhibitors; D009538:Nicotine; D009661:Nortriptyline; D010880:Piperidines; D011720:Pyrazoles; D011810:Quinoxalines; D011978:Receptors, Nicotinic; D000077285:Rimonabant; D017367:Selective Serotonin Reuptake Inhibitors; D000068580:Varenicline