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Nixing Nicotine With Novel Combination Therapies

To date, the Food and Drug Administration has approved four nicotine replacement therapy options as well as the antidepressant, bupropion (Zyban, GlaxoSmithKline), for smoking cessation.

Because some patients respond poorly to a single agent, other medications and combinations of agents that can both alleviate withdrawal symptoms and reduce nicotine's rewarding effect have been tried as a second-line approach.

These include the monoamine oxidase (MAO) inhibitor selegeline, the antihypertensive clonidine (Catapres, Boehringer Ingelheim), and combinations such as a nicotine patch plus naltrexone, and behavioral treatment plus tricyclic antidepressants. These drugs are not currently approved for tobacco cessation, however.

Genetic profiling and treatment tailoring are other hot areas of research.

Studies thus far indicate that bupropion is particularly useful for women and people with a history of depression, says Michael Fiore, MD, director of the Center for Tobacco Research and Intervention at University of Wisconsin Medical School. And researchers suggest smokeless tobacco users may increase quitting success using bupropion, nicotine lozenges, and nicotine replacement therapy dosed at levels tailored to their pre-quit nicotine consumption.¹

Behavioral intervention—particularly counseling—has been recognized as an important component of patient success with tobacco cessation, with or without pharmacotherapy.²

"We know that quit lines really have the power to make a difference," Fiore says.

Footnotes

FYI

Encourage patients to call the National Quitline Network number: 1-800-QUIT-NOW.

References

1. Perkins KA, Marcus MD, Levine MD, et al.: Cognitive-behavioral therapy to reduce weight concerns improves smoking cessation outcome in weight-concerned women. J Consult Clin Psychol 69: 604–613, 2001.[Medline]

2. Ebbert JO, Carr AB, Dale LC: Smokeless tobacco: An emerging addiction. Med Clin North Am 88: 1593–1605, 2004.[Medline]

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Holman, J. R. Search for Related Content PubMed Articles by Holman, J. R. Social Bookmarking                What's this?