Smoking nicotine-dependent

Efficacy. A pivotal study by Hurt et al. (1997) established the efficacy and safety of bupropion SRfor treatment of nicotine dependence, which led to its approval for this indication by the FDA in 1998. This study was a 7-week, double-blind, placebo-controUed, multicenter trial of three doses of bupropion SR (100 mg/day, 150 mg/day, or 300 mg/day in twice daily dosing). Patients were 6l5 cigarette smokers who smoked at least 15 cigarettes/day. The medication was administered in combination with weekly individual cessation counseling. End-of-trial 7-day point prevalence cessation rates were 19.0% for placebo and 28.8%, 38.6%, and 44.2% for the 100 mg/day, 150 mg/day, and 300 mg/day bupropion doses, respectively. At 1-year follow-up, cessation rates were 12.4% for placebo and 19.6%, 22.9%, and 23.1% for the 100 mg/day,... 

Nortriptyline. Nortriptyhne, a tricychc antidepressant, has been shown in double-blind, placebo-controlled randomized trials to be superior to placebo for smoking cessation (Prochazka et al. 1998). Nortriptyline appears to have efficacy comparable to that of bupropion for smoking cessation (Hall et al. 2002). The efficacy of this agent may be improved with more intensive behavioral therapies (Hall et al. 1998). Nortriptyline s mechanism of action is thought to relate to its noradrenergic and serotonergic reuptake blockade, because these two neurotransmitters have been implicated in the neurobiology of nicotine dependence. Side effects of nortiptyline are typical of tricyclic antidepressants and include dry mouth, blurred vision, constipation, and orthostatic hypotension. Nortriptyline appears to have some utility for smokers with a past history of major depression, and it can be recommended as a second-... 

Ling, D., Niu, T., Feng, Y., Xing, H., and Xu, X., Association between polymorphism of the dopamine transporter gene and early smoking onset an interaction risk on nicotine dependence, J. Hum. Genet., 49, 35, 2004. 

King, A., Meyer, P. Naltrexone alteration of acute smoking response in nicotine-dependent subjects. Pharmacol. Biochem. Behav. 66 563, 2000. 

Nelson CB, Wittchen HU. (1998). Smoking and nicotine dependence. Results from a sample of 14- to 24-year-olds in Germany. Eur Addict Res. 4(1-2) 42-49. 

Benowitz NL (1990) Chnical pharmacology of inhaled drags of abuse implications in understanding nicotine dependence. NIDA Res Monogr 99 12-29 Benowitz NL (1996) Cotinine as a biomarker of environmental tobacco smoke exposure. Epidemiol Rev 18(2) 188-204... 

FIND Fagerstrom test for nicotine dependence, ACC anterior cingulate cortex PFC prefrontal cortex NR not reported Data shown for FIND and pack-years are means for the smokers Pack-years = packs of cigarettes smoked per day x number of years smoked... 

---