Intervention Review

Mecamylamine (a nicotine antagonist) for smoking cessation

  1. Tim Lancaster1,*,
  2. Lindsay F Stead2

Editorial Group: Cochrane Tobacco Addiction Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 1 DEC 2010

DOI: 10.1002/14651858.CD001009

Database Title

Additional Information

How to Cite

Lancaster T, Stead LF. Mecamylamine (a nicotine antagonist) for smoking cessation. Cochrane Database of Systematic Reviews 1998, Issue 2. Art. No.: CD001009. DOI: 10.1002/14651858.CD001009.

Author Information

  1. 1

    University of Oxford, Department of Primary Health Care, Oxford, UK

  2. 2

    University of Oxford, Department of Primary Care Health Sciences, Oxford, UK

*Tim Lancaster, Department of Primary Health Care, University of Oxford, Rosemary Rue Building, Old Road Campus, Oxford, OX3 7LF, UK. tim.lancaster@dphpc.ox.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

SEARCH

ARTICLE TOOLS

View Full Article (HTML) Summary (56K)Standard (121K)Full (140K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Mecamylamine is a nicotine antagonist (that is, it blocks the effect of nicotine). The rationale for its use in smoking cessation is that it may block the rewarding effect of nicotine and thus reduce the urge to smoke.

Objectives

The objective of this review was to determine the effectiveness of mecamylamine in promoting smoking cessation, either alone or in combination with nicotine replacement therapy.

Search methods

We searched the Cochrane Tobacco Addiction Group trials register for trials using mecamylamine in October 2010.

Selection criteria

Randomized trials of mecamylamine, either alone or in combination with nicotine replacement therapy, which reported smoking cessation rates at least six months after intervention.

Data collection and analysis

The main outcome measure was sustained abstinence from smoking (biochemically validated) after at least six months follow up in patients smoking at baseline. Smokers lost to follow up were regarded as being continuing smokers. Because of the preliminary nature of available data, we did not perform meta-analysis but report the results narratively.

Main results

We identified two studies, both from the same investigators. In a study of 48 volunteers, a combination of mecamylamine plus nicotine patch was more effective than nicotine patch alone (abstinence rate at one year 37.5% vs 4.2%). In a second study, 80 volunteers were treated for four weeks prior to cessation with one of four treatments: 1. Nicotine patch plus mecamylamine capsules 2. Nicotine alone 3. Mecamylamine alone 4. No active drug. All four groups received combination treatment with nicotine and mecamylamine after the scheduled quit date. The abstinence rates in these four groups were respectively 40%, 20%, 15% and 15%. The higher abstinence rate in the group treated with combination therapy was not statistically significant. The authors reported a statistically significant benefit of mecamylamine using Kaplan-Meier survival analysis.

In the doses used, mecamylamine was well tolerated, although up to 40% of subjects required reductions in dose, usually because of constipation.

Authors' conclusions

Data from two small studies suggest that the combination of nicotine and mecamylamine may be superior to nicotine alone in promoting smoking cessation. However, these results require confirmation in larger studies before the treatment can be recommended clinically.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Does mecamylamine help people to stop smoking

Mecamylamine is a drug originally marketed for lowering blood pressure, which was found to block the rewarding effects of nicotine. At doses high enough to do this, though, mecamylamine can have significant adverse effects, including drowsiness, hypotension and constipation. It has been suggested that smaller doses may work well with nicotine replacement therapy (NRT), and the two therapies may offset each other's adverse effects. Our review of trials found that while mecamylamine did not have a great effect on quitting rates, it may enhance the effectiveness of NRT and is worth further research.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Mecamylamine(一種尼古丁拮抗劑)用於戒菸

拮抗劑阻斷尼古丁效果。使用其於戒菸的原因：可阻斷尼古丁帶來的獎賞效果，減少抽菸慾望

目標

目的為評估單獨使用mecamylamine或與其他尼古丁替代療法併用，促進戒菸的效果。

搜尋策略

2007年4月搜尋Cochrane Tobacco Addiction Group trials register 中使用mecamylamine的試驗

選擇標準

隨機試驗，單獨使用mecamylamine或與其他尼古丁替代療法併用，有介入後六個月之後的戒菸率資料。

資料收集與分析

重複擷取以下資料:受試者種類, mecamylamine和尼古丁治療的劑量和期間,治療副作用,結果變項,隨機分配方式和追蹤的完整度. 主要結果變項是:對基期有吸煙的受試者,追蹤至少6個月後的持續戒菸率(要有生化檢驗的證據). 失去追蹤的吸菸者會當成持續吸菸. 因為找到的資料都是初步資料,我們無法進行統合分析,只能簡述試驗結果

主要結論

找到2個試驗,都是來自同一位試驗主持人. 其中一個試驗有48位志願者接受試驗,結果顯示併用mecamylamine 加上plus 尼古丁貼片的療效勝過單用尼古丁貼片 (1年時的戒菸率為37.5% 比上4.2%). 另一個試驗中有80位志願者在戒煙前4週內接受以下四種治療方式之一: 1. 尼古丁貼片?用mecamylamine膠囊 2. 單獨使用尼古丁 3. 單獨使用Mecamylamine 4. 沒有使用任何藥物. 這四組受試者在計畫規定的戒菸日後,都接受尼古丁和mecamylamine併用療法. 這四組戒菸率分別為40%, 20%, 15% 和15%. 併用療法組的戒菸率較高,但沒有統計顯著. 作者提到使用KaplanMeier存活分析, mecamylamine組有統計顯著的優勢. 使用劑量方面, mecamylamine 耐受度高, 但高達 40% 受試者通常因為便秘而須降藥量.

作者結論

兩個小型試驗顯示併用尼古丁和mecamylamine 可能比單獨使用尼古丁有更好的戒菸效果. 但是,這些結果需要大行試驗驗證,才能建議於臨床使用上.

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

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

總結

單獨使用Mecamylamime 並不是戒菸的好方式, 但它可能加強尼古丁替代療法的療效. Mecamylamine原本用於低血壓控制,但被發現可阻斷尼古丁的獎勵效果. 在夠高劑量下, mecamylamine 有顯著副作用,包含嗜睡, 低血壓和便秘. 有人建議以低劑量併用尼古丁替代療法會有不錯療效, 這兩個藥物會互相減弱對方的副作用效果. 本回顧發現雖然mecamylamine對戒菸率沒有顯著影響,它卻可增強尼古丁替代療法的效果,值得深入研究.

View Full Article (HTML) Summary (56K)Standard (121K)Full (140K)