Pharmacotherapy of Nicotine Dependence

Cho, Hong Jun

Abstract

Cigarette smoking is the most important preventable cause of death in Korea. Smoking should be considered as a chronic disease attributed to nicotine dependence which needs a long term care. Nicotine dependence and withdrawal symptoms are major barriers to smoking cessation and can be successfully managed by pharmacotherapy. There are two types of pharmacotherapy for nicotine dependence, nicotine-replacement therapy(NRT) and nonnicotine-replacement therapy. Nicotine, which can be administered by patch, gum, inhaler, and nasal spray, doubled the smoking cessation rate. NRTs are usually well tolerated. Sustained-release bupropion, an antidepressant, doubled the smoking cessation rate when combined with counselling. Bupropion can induce seizure in less than 0.1% by lowering the seizure threshold. Nortriptyline and clonidine can be used as second line drugs for smoking cessation. They are similar in efficacy compared to NRT or bupropion but they frequently have adverse drug reactions. Combination of bupropion with NRT is more efficacious than NRT alone but not more effective than bupropion alone. There is no convincing evidence to recommend a specific drug for smoking cessation in women. NRT and bupropion can be useful in special situations for adolescent smokers, but evidence is not enough to recommend pharmacotherapy for adolescent smokers. Weight gain is the main barrier to smoking cessation, especially in women. Vigorous exercise reduced weight gain. Nicotine gum, bupropion also temporarily reduced weight gain after smoking cessation, but only while the drug was being administered. As there are sound evidences for the effect of pharmacotherapy in smoking cessation, it is necessary for physicians to integrate it into their daily practices.