title: New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?
abstract: A wide range of support is available to help smokers to quit and to aid attempts at harm reduction, including three first-line smoking cessation medications: nicotine replacement therapy, varenicline and bupropion. Despite the efficacy of these, there is a continual need to diversify the range of medications so that the needs of tobacco users are met. This paper compares the first-line smoking cessation medications with (1) two variants of these existing products: new galenic formulations of varenicline and novel nicotine delivery devices; and (2) 24 alternative products: cytisine (novel outside Central and Eastern Europe), nortriptyline, other tricyclic antidepressants, electronic cigarettes, clonidine (an anxiolytic), other anxiolytics (e.g. buspirone), selective serotonin reuptake inhibitors, supplements (e.g. St John's wort), silver acetate, Nicobrevin, modafinil, venlafaxine, monoamine oxidase inhibitors (MAOIs), opioid antagonists, nicotinic acetylcholine receptor (nAChR) antagonists, glucose tablets, selective cannabinoid type 1 receptor antagonists, nicotine vaccines, drugs that affect gamma-aminobutyric acid (GABA) transmission, drugs that affect N-methyl-D-aspartate (NMDA) receptors, dopamine agonists (e.g. levodopa), pioglitazone (Actos; OMS405), noradrenaline reuptake inhibitors and the weight management drug lorcaserin. Six 'ESCUSE' criteria-relative efficacy, relative safety, relative cost, relative use (overall impact of effective medication use), relative scope (ability to serve new groups of patients) and relative ease of use-are used. Many of these products are in the early stages of clinical trials; however, cytisine looks most promising in having established efficacy and safety with low cost. Electronic cigarettes have become very popular, appear to be efficacious and are safer than smoking, but issues of continued dependence and possible harms need to be considered.
authors.affiliation: Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK. e.beard@ucl.ac.uk.|Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 6BP, UK. e.beard@ucl.ac.uk.
authors.forename: Emma
authors.initials: E
authors.lastname: Beard
authors.affiliation: Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK.
authors.forename: Lion
authors.initials: L
authors.lastname: Shahab
authors.affiliation: Department of Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK.
authors.forename: Damian M
authors.initials: DM
authors.lastname: Cummings
authors.affiliation: Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 6BP, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.affiliation: Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: West
mesh_terms: D040261:Harm Reduction / Q000187:drug effects*; D006801:Humans; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D012907:Smoking / Q000188:drug therapy*; D016540:Smoking Cessation / Q000379:methods*
chemical_list: D018722:Nicotinic Agonists