Medications for tobacco cessation
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Medications for Tobacco Cessation
Introduction to Tobacco Cessation Medications
Tobacco use disorder is a chronic illness with significant health implications. Various pharmacotherapies have been developed to aid in smoking cessation, including nicotine replacement therapy (NRT), bupropion, and varenicline. Despite the availability of these treatments, long-term abstinence rates remain suboptimal, necessitating ongoing research into more effective interventions.
Antidepressants for Smoking Cessation
Bupropion and Nortriptyline
Bupropion, an atypical antidepressant, has been shown to significantly increase smoking cessation rates compared to placebo. High-certainty evidence indicates that bupropion can aid long-term smoking cessation, although it may also increase the likelihood of serious adverse events (SAEs) and treatment discontinuation due to adverse effects . Nortriptyline, another antidepressant, also appears to be effective in aiding smoking cessation, with evidence suggesting it may be as effective as bupropion .
Comparative Efficacy
When compared to other smoking cessation aids, bupropion is less effective than varenicline and combination NRT but shows similar efficacy to single-form NRT . Nortriptyline has shown beneficial effects relative to placebo, but there is insufficient evidence to determine whether it is more effective than bupropion .
Nicotine Replacement Therapy (NRT)
NRT has been a cornerstone of smoking cessation treatment since its development in 1978. It works by providing a controlled dose of nicotine to reduce withdrawal symptoms and cravings. Studies have shown that higher adherence to NRT increases the likelihood of sustained smoking cessation . However, many smokers use NRT at lower doses and for shorter durations than recommended, which can limit its effectiveness .
Varenicline and Cytisine
Varenicline
Varenicline, a nicotine receptor partial agonist, has been shown to be more effective than both bupropion and single-form NRT in helping people quit smoking. High-certainty evidence supports its efficacy, although it may increase the risk of SAEs. Varenicline works by maintaining moderate dopamine levels to counteract withdrawal symptoms and reducing smoking satisfaction.
Cytisine
Cytisine, another nicotine receptor partial agonist, has shown promise in aiding smoking cessation, particularly in Central and Eastern Europe. It is less effective than varenicline but may lead to fewer reported SAEs . Further research is needed to compare its efficacy and safety directly with varenicline and other pharmacotherapies.
Emerging Pharmacotherapies
Several novel pharmacotherapies are being investigated for smoking cessation, including acetylcholinesterase inhibitors, N-acetylcysteine, and various anxiolytics. These emerging treatments show promise but require further high-quality randomized controlled trials to establish their efficacy and safety .
Conclusion
Current pharmacotherapies for smoking cessation, including NRT, bupropion, and varenicline, have proven efficacy but are not sufficient to achieve high long-term abstinence rates. Antidepressants like bupropion and nortriptyline can aid smoking cessation, but their use is associated with increased adverse events. Varenicline is more effective than bupropion and single-form NRT, while cytisine offers a potentially safer alternative. Ongoing research into novel pharmacotherapies is essential to develop more effective smoking cessation aids and reduce the global burden of tobacco-related diseases.
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