Clonidine for smoking cessation

 

Abstract

Background

Clonidine was originally used to lower blood pressure. It acts on the central nervous system and may reduce withdrawal symptoms in various addictive behaviours, including tobacco use.

Objectives

The aim of this review is to determine clonidine's effectiveness in helping smokers to quit.

Search methods

We searched the Cochrane Tobacco Addiction Group trials register for trials of clonidine. Date of the most recent search: June 2008.

Selection criteria

We considered randomized trials of clonidine versus placebo with a smoking cessation endpoint assessed at least 12 weeks following the end of treatment.

Data collection and analysis

We extracted data in duplicate on the type of subjects, the dose and duration of clonidine therapy, the outcome measures, method of randomization, and completeness of follow up.

The main outcome measure was abstinence from smoking after at least 12 weeks follow up in patients smoking at baseline. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed effect model.

Main results

Six trials met the inclusion criteria. There were three trials of oral, and three of transdermal clonidine. Some form of behavioural counselling was offered to all participants in five of the six trials.

There was a statistically significant effect of clonidine in one of these trials. The pooled risk ratio for success with clonidine versus placebo was 1.63 (95% confidence interval 1.22 to 2.18). There was a high incidence of dose-dependent side-effects, particularly dry mouth and sedation.

Authors' conclusions

Based on a small number of trials, in which there are potential sources of bias, clonidine is effective in promoting smoking cessation. Prominent side-effects limit the usefulness of clonidine for smoking cessation.

 

Plain language summary

Does clonidine help smokers to quit

Clonidine is a drug used to lower blood pressure, but it may also reduce drug and alcohol withdrawal symptoms. The review of trials found that clonidine can lead to a small increase in the number of people likely to quit smoking. However, the quality of the trials was poor, which makes the evidence less reliable. Adverse effects of clonidine included a dry mouth and sedation. Clonidine may not be the best option for people trying to quit smoking, but it might be useful for people who are not helped by nicotine replacement therapy or antidepressants.

 

摘要

背景

clonidine在戒煙

clonidine原本是用來降血壓的，它作用在中樞神經且可以減少多種成癮行為的戒斷症狀，包括菸草的使用

目標

此篇回顧的目的在確定clonidine在協助抽煙者戒煙的效果

搜尋策略

我們搜尋Cochrane Tobacco Addiction Group trials register的clonidine試驗，最後的搜尋日期是西元2006年4月

選擇標準

我們考慮納入的是clonidine及安慰劑的隨機試驗，這些試驗在停止治療後至少有12週的戒煙評估

資料收集與分析

我們選取的資料有一樣類型的試驗對象，一樣的clonidine治療劑量和治療時間，一樣結果的測量，一樣的隨機方法，和一樣的後續追蹤完整性，主要結果測量是戒煙後至少12週的評估，我們在每個試驗用最嚴格的戒煙定義，如果有生化驗證率可取得的話。適合情況下，我們使用固定效果模式來做統合分析

主要結論

6個試驗符合納入的條件，3個試驗是口服藥物，另外3個是經皮吸收的clonidine，在6個試驗中的5個有提供行為諮商給試驗者，在這些試驗中，clonidine在一個試驗中達顯著的效果，而這些試驗統合起來看，以clonidine相對於安慰劑成功戒煙的勝算比是1.89(95% confidence interval 1.30 to 2.74)。而clonidine有隨劑量增加的副作用的高發生率，特別是口乾及鎮靜

作者結論

由這些小數目的且可能有潛在的資料偏差試驗來看，clonidine在促進戒煙是有效的，而顯著的副作用限制了clonidine在戒煙上的使用

翻譯人

本摘要由彰化基督教醫院許文郁翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

Clonidine可以協助戒菸，但它有副作用。 Clonidine是一種用來降低血壓藥物，但它也可以減少藥物和酒精戒斷症狀。文獻回顧發現clonidine可以在想戒菸的人中，少量增加戒菸成功。然而，試驗的質量是不佳的，這使得證據不太可靠。Clonidine的副作用包括口乾和鎮靜。Clonidine未必是想嘗試戒菸者的最佳選擇，但它對於無尼古丁替代療法及抗鬱劑協助的個案可能是有用的