Nicotine replacement therapy for

Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2004. 

GRAPEFRUIT JUICE NICOTINE Significant t renal clearance of nicotine Grapefruit juice inhibits the formation of cotinine from nicotine, t renal clearance of cotinine and 1 plasma concentrations of cotinine by 15% Be aware in patients using varying forms of nicotine replacement therapy for stopping smoking... 

Cepeda-Benito, A., Reynexso, J. T., 8c Erath, S. (2004). Meta-analysis of the efficacy of nicotine replacement therapy for smoking cessation Differences betw-een men and women. Journal of Consulting and Clinical Psychology, 72,712-722. 

The Cochrane Library is a relatively new and growing electronic library that provides more than 850 summaries of published literature about pharmaceutical and other interventions to improve health. The Library adds new titles four times a year to its cumulative online and CD versions (the latter, available by subscription, offers more databases). The Library s 2000 Issue 3 contains evidence on dozens of clinical dilemmas, such as antibiotic treatment for traveler s diarrhea, antileukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma, opioid antagonists for alcohol dependence, and bromocriptine versus levodopa in early Parkinson s disease. The Cochrane Library also updates earlier reviews when important new evidence becomes available. Among the newest updates are tacrine for Alzheimer s disease, tricyclic and related drugs for nocturnal enuresis in children, and nicotine replacement therapy for smoking cessation. 

Bupropion is efficacious alone and in combination with nicotine replacement therapy for smoking cessation. 

Some clinicians are hesitant to prescribe nicotine replacement therapy for smoking cessation during pregnancy because the safety and efficacy of nicotine replacement therapy has not been established in controlled clinical trials in this population. 

In general, for smokers with cardiac disease, the benefits of nicotine replacement therapy outweigh the potential risks. In a safety and efficacy study that included veterans with cardiac disease, smoking concurrently with the nicotine patch was not associated with an increase in adverse events (Joseph et al. 1996). Although bupropion SR is generally well tolerated by smokers, it has not been adequately studied in persons with cardiac disease, and definitive conclusions regarding its safety in this patient population cannot currently be made (Society for Research on Nicotine and Tobacco 2003). 

Nicotine is responsible for the highly addictive properties of tobacco products. Addiction occurs in 30% of those who experiment with tobacco products, and more than 80% of those who attempt to quit smoking will relapse within a year. Withdrawal from nicotine produces a syndrome characterized by nicotine craving as well as dysphoria, anxiety, irritability, restlessness and increased appetite. It is treated with nicotine replacement therapies, such as nicotine gum and patches, and/or with buproprion, a drug that is classified as an antidepressant but has multiple and complex effects in brain. Buproprion reduces craving in some smokers. Nicotine addiction has been reviewed recently at cellular and systems levels [38-41]. 

Assessment and reduction in the use of alcohol, tobacco, and other substances prior to pregnancy improve outcomes. For smoking cessation, behavioral interventions are preferred. Intermittent delivery formulations of nicotine replacement therapies are preferred over the patches. If patches are used, 16-hour patches are preferred over 24-hour patches. 

Nicotine replacement therapies can be combined with each other and/or bupropion to increase long-term abstinence rates. bOo not abruptly discontinue. Taper up initially, and taper off once therapy is complete. cClonidine and nortriptyline are not FDA approved for smoking cessation. 

An understanding of the pharmacology of nicotine and how nicotine produces addiction and influences smoking behavior provides a necessary basis for therapeutic advances in smoking cessation interventions. This chapter provides a review of several aspects of the human pharmacology of nicotine. These include the presence and levels of nicotine and related alkaloids in tobacco products, the absorption of nicotine from tobacco products and nicotine medications, the distribution of nicotine in body tissues, the metabolism and renal excretion of nicotine, nicotine and cotinine blood levels during tobacco use or nicotine replacement therapy, and biomarkers of nicotine exposure. For more details and references on the pharmacokinetics and metabolism of nicotine, the reader is referred to Hukkanen et al. (2005c). 

Jacob P, 3rd, Hatsukami D, Severson H, Hall S, Yu L, Benowitz NL (2002) Anabasine and anatabine as biomarkers for tobacco use during nicotine replacement therapy. Cancer Epidemiol Biomarkers Prev 11(12) 1668-1673... 

Women have greater vulnerability for smoking-related diseases (specifically myocardial infarction and lung cancer) than men, but are less successful in quitting smoking (Harris et al. 1993 Zang and Wynder 1996 Thun et al. 2002 Henschke and Miettinen 2004 Henschke et al. 2006). Men benefit from nicotine replacement therapy more than women (reviewed by Perkins 2001). A recent meta-analysis of nicotine versus placebo patch studies has shown a significantly better response to nicotine in men than women (Perkins and Scott 2008). 

While nicotine is the primary active pharmacological agent, tobacco has been shown to be a particularly effective vehicle for delivery of nicotine (US Food and Drug Administration 1995 Hurt and Robertson 1998 Slade et al. 1995 World Health Organization 2001). In fact, published research has determined that tobacco-delivered nicotine is not only more toxic, but more addictive than nicotine in a pure form (e.g., nicotine replacement therapy) (Henningfleld et al. 2000 Royal College of Physicians 2000). As noted by a BW scientist in 1990 Nicotine alone in smoke is not practical, nor are extreme tar/nicotine ratios, since nicotine is too irritating -other substances are required for sensoric reasons (Baker 1990). 

Henningfield JE, Woodson PP (1989) Dose-related actions of nicotine on behavior and physiology Review and implications for replacement therapy for nicotine dependence. J Subst Abuse, 1 301-317... 

Patients who are especially sensitive to the physical symptoms of nicotine withdrawal may benefit from the addition of a nicotine replacement that is eventually tapered over a period of time (see Table 6.4). It is very important for the patient to abstain from tobacco use (both smoked and chewed) during nicotine replacement therapy. 

In nicotine replacement therapy, the chewing gum releases nicotine, which is absorbed through the buccal mucosa every time a piece of chewing gum is chewed. The chewing gum is chewed for 30 minutes, only when one feels the urge to smoke. The transdermal patch provides a residual nicotine level throughout the application. A side-effect of nicotine chewing gum may be aphthous ulcers. 

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