Recent advances in the pharmacotherapy of smoking.

Since the 1996 publication of guidelines on smoking cessation from the Agency for Health Care Policy and Research and the American Psychiatric Association, several new treatments have become available, including nicotine nasal spray, nicotine inhaler, and bupropion hydrochloride. In addition, nicotine gum and patch have become available over-the-counter. This article reviews the published literature and US Food and Drug Administration and pharmaceutical company reports on these therapies. Based on this review, clinical logic, and experience, we conclude that pharmacotherapy should be made available to all smokers. All currently available therapies appear to be equally efficacious, approximately doubling the quit rate compared with placebo. Concomitant behavioral or supportive therapy increases quit rates and should be encouraged but not required. Combining patch with gum or patch with bupropion may increase the quit rate compared with any single treatment. Because patient characteristics predictive of success with a particular therapy are not yet known, the best treatment choice for an individual patient should be guided by the patient's past experience and preference and the product's adverse effect profile.

[1]  C. Patten,et al.  Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism∗ , 1999, British Journal of Psychiatry.

[2]  K. Fagerström,et al.  Nicotine replacement: a new approach to reducing tobacco-related harm. , 1998, The European respiratory journal.

[3]  J. Hughes.  Taking smoking cessation treatment seriously: the American Psychiatric Association's Practice Guideline for the Treatment of Patients with Nicotine Dependence. , 1996, Addiction.

[4]  S. Shiffman,et al.  Public health benefit of over-the-counter nicotine medications. , 1997, Tobacco control.

[5]  Darrell R. Schroeder,et al.  A Comparison of Sustained-Release Bupropion and Placebo for Smoking Cessation , 1997 .

[6]  N. Benowitz,et al.  Arteriovenous differences in plasma concentration of nicotine and catecholamines and related cardiovascular effects after smoking, nicotine nasal spray, and intravenous nicotine , 1997, Clinical pharmacology and therapeutics.

[7]  Å. Westin,et al.  A double-blind randomized trial of nicotine nasal spray as an aid in smoking cessation. , 1997, The European respiratory journal.

[8]  N. Benowitz,et al.  Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy. , 1997, Journal of the American College of Cardiology.

[9]  K. Cummings,et al.  What should be the elements of any settlement with the tobacco industry? , 1997, Tobacco Control.

[10]  K. Overvad,et al.  Nicotine patches in smoking cessation: a randomized trial among over-the-counter customers in Denmark. , 1997, American journal of epidemiology.

[11]  K. Schuh,et al.  Nicotine nasal spray and vapor inhaler: abuse liability assessment , 1997, Psychopharmacology.

[12]  S. Leischow,et al.  Efficacy of the Nicotine Inhaler as an Adjunct to Smoking Cessation , 1996 .

[13]  Shu-Hong Zhu,et al.  Telephone Counseling for Smoking Cessation: What's in a Call? , 1996 .

[14]  R. Olmstead,et al.  Efficacy of a nicotine inhaler in smoking cessation: a double-blind, placebo-controlled trial. , 1996, Addiction.

[15]  K. Fagerström,et al.  Clinical Pharmacokinetics of Nasal Nicotine Delivery , 1996, Clinical pharmacokinetics.

[16]  R. Glasgow,et al.  Telephone counseling for smoking cessation: rationales and meta-analytic review of evidence. , 1996, Health education research.

[17]  Timothy B. Baker,et al.  THE AGENCY FOR HEALTH CARE POLICY AND RESEARCH SMOKING CESSATION CLINICAL PRACTICE GUIDELINE , 1996 .

[18]  K. Fagerström,et al.  Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers. , 1996, Tobacco control.

[19]  W. Bailey,et al.  Safety of nicotine polacrilex gum used by 3,094 participants in the Lung Health Study. Lung Health Study Research Group. , 1996, Chest.

[20]  M. Jarvik,et al.  Efficacy of a nicotine nasal spray in smoking cessation: a placebo-controlled, double-blind trial. , 1995, Addiction.

[21]  M. Law,et al.  An analysis of the effectiveness of interventions intended to help people stop smoking. , 1995, Archives of internal medicine.

[22]  E. Vartiainen,et al.  Combined use of nicotine patch and gum compared with gum alone in smoking cessation - a clinical trial in North Karelia , 1995 .

[23]  J. Feighner,et al.  Bupropion: a review of its mechanism of antidepressant activity. , 1995, The Journal of clinical psychiatry.

[24]  A. Forbes,et al.  Double blind trial of repeated treatment with transdermal nicotine for relapsed smokers , 1995, BMJ.

[25]  A. Nordberg,et al.  Regional deposition of inhaled 11C‐nicotine vapor in the human airway as visualized by positron emission tomography , 1995, Clinical pharmacology and therapeutics.

[26]  M. Fiore,et al.  Smoking cessation treatment and the good doctor club. , 1995, American journal of public health.

[27]  G. Gustavsson,et al.  Combined use of nicotine patch and gum in smoking cessation: a placebo-controlled clinical trial. , 1995, Preventive medicine.

[28]  J. Hughes,et al.  Combining behavioral therapy and pharmacotherapy for smoking cessation: an update. , 1995, NIDA research monograph.

[29]  Å. Westin,et al.  Effect of nicotine nasal spray on smoking cessation. A randomized, placebo-controlled, double-blind study. , 1994, Archives of internal medicine.

[30]  K. Fagerström.  Combined use of nicotine replacement products. , 1994 .

[31]  W. Hall,et al.  Meta-analytic review of the efficacy of smoking cessation interventions. , 1994, Drug and alcohol review.

[32]  J. Hughes.  Pharmacotherapy for smoking cessation: unvalidated assumptions, anomalies, and suggestions for future research. , 1993, Journal of consulting and clinical psychology.

[33]  P. Tønnesen,et al.  Recycling with nicotine patches in smoking cessation. , 1993, Addiction.

[34]  P. Tønnesen,et al.  A double-blind trial of a nicotine inhaler for smoking cessation. , 1993, JAMA.

[35]  D. Abrams,et al.  Introduction , 1993, Tobacco Control.

[36]  M. Jarvis,et al.  Randomised controlled trial of nasal nicotine spray in smoking cessation , 1992, The Lancet.

[37]  J. L. Schwartz,et al.  Methods for smoking cessation. , 1992, Clinics in chest medicine.

[38]  N. Benowitz.  Nicotine replacement therapy during pregnancy. , 1991, JAMA.

[39]  Miller Lg.  Cigarettes and drug therapy: pharmacokinetic and pharmacodynamic considerations. , 1990 .

[40]  S. Fortmann,et al.  Evaluation of a treatment approach combining nicotine gum with self-guided behavioral treatments for smoking relapse prevention. , 1990, Journal of consulting and clinical psychology.

[41]  R N Battista,et al.  Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials. , 1988, JAMA.

[42]  J. Hughes,et al.  Dependence potential and abuse liability of nicotine replacement therapies. , 1988, Progress in clinical and biological research.

[43]  M. Jarvik,et al.  Nicotine gum in smoking cessation: a placebo-controlled, double-blind trial. , 1983, Addictive behaviors.