Effectiveness of nicotine patch and nicotine gum as individual versus combined treatments for tobacco withdrawal symptoms

Fagerström, Karl; Schneider, Nina; Lunell, Erik

doi:10.1007/bf02244941

Cited by 168 publications

(91 citation statements)

References 17 publications

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“…replacing only a part of the nicotine taken in from smoking, is very common. A method to ameliorate the underdosing has been to combine several NR products, most commonly as patch plus gum [15,16]. There is evidence from a meta-analysis that combining a nicotine patch with an oral form of NR was more effective than a single type of NR [3].…”

Section: Indications For Nrcontrasting

confidence: 40%

Pharmacological treatments for tobacco dependence

Fagerström¹,

Jiménez-Ruíz²

2008

Eur Respir Rev

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There are currently three licensed therapies for smoking cessation: nicotine replacement (NR), bupropion and varenicline.NR can be indicated for: 1) aid in abrupt cessation; 2) gradual reduction in order to quit smoking; 3) temporary abstinence; and 4) smoking reduction maintenance. A meta-analysis has found that the relative risk of abstinence for any form of NR relative to control was 1.6. It has been found that starting NR treatment 1-3 weeks before smoking cessation and combining NR products, usually patch and gum, increases efficacy. Recently some new nicotine administration forms, i.e. lozenge, mouth spray and a pouch, have been developed. They seem to have the potential to relieve cravings faster than the current high-dose gum, and also be more preferred.Varenicline is a selective partial agonist at the a 4 b 2 nicotinic acetylcholine receptors (nAChR). It decreases cravings and alleviates the symptoms of withdrawal. It can also reduce the rewarding and reinforcing effects of nicotine. Trials have shown varenicline to have increased efficacy relative to bupropion. Varenicline has also been compared with NR (21 mg transdermal patch) in one randomised study. Abstinence at the end of treatment at 12 weeks was significantly increased for varenicline (56%) compared with for nicotine patch (43%). Some post-marketing reports have expressed concern about psychiatric adverse effects, such as aggression, depression and suicides. The European Medicines Agency and the Food and Drug Administration of the USA are monitoring reported side-effects, but so far no confirmed casual relationship between these adverse effects and varenicline has been established.Bupropion inhibits neuronal re-uptake of dopamine and norepinephrine and is an antagonist on the nAChR. Its efficacy, compared with placebo, has been proved in several meta-analyses. A recent study suggests that longer pre-cessation use of bupropion, e.g. for 4 weeks, can improve efficacy results.Under development for the treatment of tobacco dependence are cannabinoid antagonists, immunotherapy against nicotine, monoaminooxidase inhibitors, dopamine receptor D3 receptor antagonists and partial agonists, glutamatergic and GABA-ergic compounds and novel selective nicotine cholinergic receptor agonists and antagonists.

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Section: Indications For Nrcontrasting

confidence: 40%

Pharmacological treatments for tobacco dependence

Fagerström¹,

Jiménez-Ruíz²

2008

Eur Respir Rev

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“…This approach is therefore not a feasible way to increase abstinence rates beyond those observed in this study. Therefore, the present focus on the combined use of different nicotine treatments and dosage patterns during therapy is a worthwhile approach [13][14][15]. The transdermal route is a fixed dose system with a low frequency of adverse effects.…”

Section: Discussionmentioning

confidence: 99%

A double-blind randomized trial of nicotine nasal spray as an aid in smoking cessation

Blöndal

Franzon²,

Westin³

1997

Eur Respir J

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A double-blind randomized trial of nicotine nasal spray as an aid in smoking cessation. T. Blöndal, M. Franzon, A. Westin. ERS Journals Ltd 1997. ABSTRACT: The objective of the study was to evaluate the therapeutic efficacy of nicotine nasal solution (NNS) for smoking cessation from the stopping day up to 3 months. We also followed the participants for 2 yrs after ceasing smoking to assess what happens after stopping using NNS.In a placebo-controlled, double-blind, 2 yr prospective study, 157 smokers were given either NNS, one dose containing 1 mg of nicotine per 100 µL (n=79), or placebo (n=78). Treatment was continued for up to 1 yr.One day after quitting smoking, the average number of daily doses was 11 in the group assigned NNS and 14 in the group assigned the placebo, and after 6 weeks, 14 and 6 doses, respectively, among abstinent participants still using spray. After 3 months, 65% of the abstainers in the nicotine group were still using the NNS. The abstinence rates were 51, 39 and 29% after 6 weeks, 3 and 6 months, respectively, as compared to 24, 19 and 18% in the placebo group (p=0.0003; p=0.003; p=0.050). The proportion abstinent at the 1 yr (25 vs 17%) and 2 yr follow-ups (19 vs 14%) was higher among those assigned to the nicotine than to the placebo group, but not significantly so for the numbers used in the study.In conclusion, the use of nicotine nasal spray significantly increased the abstinence rate during the first 6 months following the quitting day. Eur Respir J 1997; 10: 1585-1590 The use of nicotine combined with group support during the initial period after stopping smoking, has been shown to be of value in numerous investigations. Nicotine polacrilex gum and nicotine transdermal patches [1,2] are well established as aids to smoking cessation. Other nicotine delivery systems include nasal spray [3][4][5], which has now been approved for use in 11 countries, and a nicotine inhaler [6].The aim of this study was to investigate the effect of a nicotine nasal spray (NNS) in the withdrawal phase of smoking cessation. Nicotine absorption is slow from nicotine polacrilex gum and particularly so from the transdermal patch. The serum nicotine levels attained are far below pretreatment smoking levels. Serum nicotine levels in gum users are seldom more than one third those of smoking levels [1], while the nicotine from nasal sprays is absorbed sufficiently rapidly to produce subjective effects similar to those from smoking and produce blood levels of ~40% of the smoking range [3,7].We attempted to investigate the effect of nicotine nasal spray treatment for up to 3 months and to assess the abstinence rates up to 1 yr after stopping the use of nicotine spray (2 yrs after quitting smoking). Methods Subjects and randomizationRecruitment for the study was done by newspaper advertisement in the second half of 1989. To be eligible, subjects had to be 21-68 yrs old and had to smoke at least 1 cigarette·day -1 . Subjects had to be motivated to stop smoking and be willing to adhere to the trial protocol. The ...

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“…Additionally, Killen et al (2001) recently reported that nicotine replacement therapy fails to attenuate withdrawal symptoms in adolescents, findings that contrast with reports of the effectiveness of these treatment approaches in adults (Rose et al, 1985;Fagerstrom et al, 1993).…”

mentioning

confidence: 86%

Withdrawal from chronic nicotine in adolescent and adult rats

Wilmouth

Spear

2006

Pharmacology Biochemistry and Behavior

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The purpose of the present experiment is to assess potential differences in nicotine withdrawal in both adolescent and adult rats. Nicotine dependence was induced via osmotic minipump in adolescent rats (releasing 22.2 mg/kg/day on Postnatal Day 28) and adults (release rate of 18.4 mg/kg/day on Postnatal Day 60); differential initial release rates were used across age to compensate for the more rapid weight gain of adolescence. On Day 7 of nicotine exposure, withdrawal was induced via the administration of a nicotinic antagonist, mecamylamine (1.0 mg/kg i.p.), and withdrawal-induced anxiogenesis assessed on the elevated plus maze. On Days 1 and 4 after pump removal, animals were examined for startle responses and prepulse inhibition in an acoustic startle chamber. Adult animals exhibited a nicotine withdrawal-induced increase in anxiety, while adolescents did not. One day following the removal of minipumps, only nicotine dependent adolescent animals exhibited a disruption in prepulse inhibition. Nicotine withdrawal failed to produce an alteration in acoustic startle response in either group. Together these data suggest that ontogenic differences in nicotine withdrawal are dependent on the withdrawal measure examined, with adolescents being less sensitive than adults to anxiety-like symptoms, while being more sensitive to withdrawal-induced cognitive disruption.Despite the overall decrease in adolescent tobacco use that has occurred in the past 10 years, the prevalence of use among teens is still quite high, with 50% of 12 th graders reporting trying smoking and 23% reporting smoking within the last 30 days in 2005 (Johnston, et al

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Effectiveness of nicotine patch and nicotine gum as individual versus combined treatments for tobacco withdrawal symptoms

Cited by 168 publications

References 17 publications

Pharmacological treatments for tobacco dependence

Pharmacological treatments for tobacco dependence

A double-blind randomized trial of nicotine nasal spray as an aid in smoking cessation

Withdrawal from chronic nicotine in adolescent and adult rats

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