Pharmacotherapy for tobacco cessation: nicotine agonists, antagonists, and partial agonists.
Nicotine replacement therapies (NRT) were the main pharmacologic option for treatment of nicotine dependence until the early 1990s, when controlled clinical trials confirmed the efficacy of bupropion, the first treatment not based on nicotine. Varenicline, a partial agonist at nicotine receptors, gained US regulatory approval in 2006 for smoking cessation. Although these agents are all effective for nicotine dependence, their efficacy rates vary compared with placebo (overall OR for NRT efficacy, 1.77; for bupropion, 1.94; for varenicline, 3.09). Each of these treatments has a place, sometimes in combinations with other agents, in cancer patients who continue to smoke. Our initial experience with varenicline has been encouraging. Bupropion has specific advantages for cancer patients, including increased energy, low risk for nausea, and decreased weight gain from quitting.
Karam-Hage
Maher
M
Division of Cancer Prevention, Department of Behavioral Science, The University of Texas M.D. Anderson Cancer Center, 1155 Pressler Street, CPB, Unit 1330, Houston, TX 77030, USA. maherkaram@mdanderson.org
Cinciripini
Paul M
PM
D002986:Clinical Trials as Topic; D006801:Humans; D009538:Nicotine / Q000008:administration & dosage / Q000819:agonists* / Q000037:antagonists & inhibitors*; D012907:Smoking / Q000188:drug therapy*; D020340:Tobacco Use Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000188:drug therapy*
D009538:Nicotine