Cigarette cessation drugs
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Cigarette Cessation Drugs: An Overview of Current and Emerging Therapies
Introduction to Smoking Cessation Drugs
Cigarette smoking remains a leading cause of preventable death worldwide. Various pharmacological interventions have been developed to aid smoking cessation, including nicotine replacement therapy (NRT), varenicline, bupropion, and e-cigarettes. This article synthesizes the latest research on the effectiveness, safety, and cost-effectiveness of these interventions.
Nicotine Replacement Therapy (NRT)
Effectiveness and Forms of NRT
Nicotine replacement therapy (NRT) aims to reduce withdrawal symptoms by providing nicotine without the harmful effects of smoking. NRT is available in various forms, including gum, patches, nasal sprays, inhalers, and lozenges. Research indicates that all forms of NRT are effective in increasing smoking cessation rates compared to placebo, with a pooled risk ratio (RR) of 1.58 10. Combining different forms of NRT, such as a patch with a rapid delivery form, has shown to be more effective than using a single type 10.
Safety and Tolerability
NRT is generally well-tolerated, with side effects being mild and transient. The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual 10.
Varenicline
Mechanism and Effectiveness
Varenicline is a nicotine receptor partial agonist that helps reduce withdrawal symptoms and smoking satisfaction. High-certainty evidence shows that varenicline is more effective than placebo (RR 2.32) and other smoking cessation aids like bupropion and single-form NRT 4. It is also comparable in effectiveness to combination NRT 4.
Safety Concerns
While varenicline is effective, it may increase the likelihood of serious adverse events (SAEs) compared to placebo, with a moderate-certainty evidence suggesting a higher risk of SAEs (RR 1.23) 4. However, the evidence is mixed regarding its impact on neuropsychiatric and cardiac SAEs 4.
Bupropion
Mechanism and Effectiveness
Bupropion, an antidepressant, is another effective smoking cessation aid. High-certainty evidence indicates that bupropion increases long-term smoking cessation rates compared to placebo (RR 1.64) 67. However, it is less effective than varenicline and combination NRT 7.
Safety and Tolerability
Bupropion is associated with an increased risk of adverse events, including psychiatric symptoms and treatment discontinuation due to side effects 67. There is moderate-certainty evidence that bupropion may slightly increase the frequency of SAEs, although the confidence intervals also encompass no difference 67.
E-Cigarettes
Effectiveness and Safety
E-cigarettes are increasingly used as a smoking cessation tool. High-certainty evidence suggests that nicotine e-cigarettes are effective in increasing quit rates compared to placebo (OR 2.37) 2. However, the long-term safety of e-cigarettes remains uncertain, and more research is needed to compare their effectiveness and safety with other pharmacotherapies 12.
Emerging Therapies
Cytisine and Other Novel Agents
Cytisine, a plant-based alkaloid, has shown promise as an effective smoking cessation aid, with high-certainty evidence supporting its efficacy (OR 2.21) 24. Other emerging therapies include N-acetylcysteine, cycloserine, and various novel nicotine delivery devices, which are currently under investigation 58.
Antidepressants and Other Non-Nicotinic Therapies
Antidepressants like nortriptyline have also been studied for smoking cessation. Moderate-certainty evidence suggests that nortriptyline is effective compared to placebo (RR 2.03) 67. Other non-nicotinic therapies, such as clonidine and nicotine vaccines, are being explored but require further research to establish their efficacy and safety 9.
Conclusion
In summary, a variety of pharmacological interventions are available to aid smoking cessation, each with its own benefits and risks. NRT, varenicline, and bupropion are well-established options, while e-cigarettes and emerging therapies like cytisine offer additional choices. Future research should continue to explore the long-term effectiveness and safety of these interventions to provide smokers with the best possible support for quitting.
Sources and full results
Most relevant research papers on this topic
Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis.
Smoking cessation medicines and e-cigarettes are effective in achieving sustained abstinence, with varenicline and nicotine replacement therapy being the most effective, but bupropion may increase the odds of serious adverse events.
Meta-Analysis
Highly CitedPharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta‐analyses
E-cigarettes show potential benefits for smoking cessation, but their use is limited by the risk of serious adverse events and limited by the availability of pharmacotherapies.
Meta-AnalysisPharmacokinetic Drug Interactions with Tobacco, Cannabinoids and Smoking Cessation Products
Tobacco and marijuana smoking induce CYP1A2, and smoking cessation may require dose reduction of CYP1A drugs to prevent toxicity.
Rigorous JournalHighly CitedNicotine receptor partial agonists for smoking cessation
Nicotine receptor partial agonists, such as varenicline and cytisine, effectively help people quit smoking, with high certainty for varenicline and moderate certainty for cytisine.
Meta-AnalysisNew Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?
Cytisine shows promise as an affordable, effective smoking cessation medication, while electronic cigarettes show promise as a safer alternative to smoking.
Very Rigorous JournalAntidepressants for smoking cessation.
Bupropion effectively increases long-term smoking cessation rates, with insufficient evidence to determine if it increases the risk of serious adverse events.
Meta-AnalysisVery Rigorous JournalAntidepressants for smoking cessation
Antidepressants, particularly bupropion, can increase smoking cessation rates when used alone or in combination with varenicline.
Meta-AnalysisCurrent and Emerging Pharmacotherapies for Cessation of Tobacco Smoking
Combination NRT and varenicline show the greatest smoking cessation rates, while novel therapies like acetylcholinesterase inhibitors, cytisine, and N-acetylcysteine show promising results.
Systematic ReviewNon-nicotinic therapies for smoking cessation.
New therapeutic products are emerging to provide smokers with additional options for achieving smoking cessation, including nicotine vaccines and inhibitors of nicotine metabolism.
Highly CitedNicotine replacement therapy for smoking cessation.
Nicotine replacement therapy (NRT) is effective in aiding smoking cessation, with different forms and dosages showing different effects, and combinations of NRT may be more effective than single types.
Meta-AnalysisHighly Cited