New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?

Abstract

A wide range of support is available to help smokers to quit and aid attempts at harm reduction, including three first-line smoking cessation medications: nicotine replacement therapy, varenicline and bupropion. Despite the efficacy of these, there is a continual need to diversify the range of medications so that the needs of tobacco users are met. This paper compares the first-line smoking cessation medications to: 1) two variants of these existing products: new galenic formulations of varenicline and novel nicotine delivery devices; and 2) twenty-four alternative products: cytisine (novel outside of central and eastern Europe), nortriptyline, other tricyclic antidepressants, electronic cigarettes, clonidine (an anxiolytic), other anxiolytics (e.g. buspirone), selective 5-hydroxytryptamine Key points: This paper reviews 26 pharmacotherapies that have been investigated for tobacco harm reduction and smoking cessation alongside three first-line treatments (nicotine replacement therapy, varenicline and bupropion) on six criteria: relative efficacy, relative safety, relative cost, relative use, relative scope, and relative ease of use. Although many of these products are in the early stages of clinical trials, of all the medications considered, cytisine appears to offers the best prospect for the future, having established safety and efficacy and being very inexpensive. Electronic cigarettes have become very popular in some countries but efficacy and long-term safety compared with other treatment profiles require further consideration.

Current and Emerging Pharmacotherapies for Cessation of Tobacco Smoking

“…Since the creation of a chewing gum formulation in 1978, the NRT market has continued to evolve, developing patches, oral and nasal sprays, inhalers, and lozenges . The use of NRT is based on the rationale that substituting cigarettes with controlled doses of nicotine would prevent exposure to the harmful substances found in cigarettes .…”

“…With its high comorbidity rate, tobacco is a major cause of years of life lost or years lived with disability . It is considered the foremost preventable cause of death in developed countries and yet is responsible for more than 5 million deaths per year . Tobacco smoke also affects passive smokers who will suffer its harmful effects .…”

Innovative approaches to support smoking cessation for individuals with mental illness and co-occurring substance use disorders

“…Therefore, kappa antagonists may reduce some of the kappa-mediated anxiety and withdrawal [50]. Research also is ongoing with phase I and II clinical trials for nicotine vaccines, which produce antibodies that bind to nicotine to prevent nicotine from acting on receptors [51]. We are unaware of any studies in psychiatric samples.…”

Tabaco y peso corporal

“…Ha sido aprobado por la fDA (Food and Drug Administration, uSA) en junio de 2012 para el tratamiento de sobrepeso con comorbilidad u obesidad. un estudio clínico reciente en fase ii demostró que la lorcaserina se asoció con una tasa mayor en el cese del tabaquismo sumado a una reducción en el peso corporal comparado con placebo 8 . Por otra parte, estudios en animales han demostrado que lorcaserina reduce la autoadministración de nicotina 9 .…”