Pharmacotherapy for Nicotine Dependence1

Authors

  • Dr. Jack E. Henningfield PhD,

    1. Henningfield is Vice President, Research and Health Policy, Pinney Associates, Bethesda, MD; Professor, Adjunct, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
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  • Dr. Reginald V. Fant PhD,

    1. Fant is Director, Clinical Pharmacology, Pinney Associates, Bethesda, MD
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  • Dr. August R. Buchhalter PhD,

    1. Buchhalter is Scientist, Pinney Associates, Bethesda, MD
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  • Dr. Maxine L. Stitzer PhD

    1. Stitzer is Professor, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
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  • 1

    1JEH, RVF, and ARB consult on tobacco-dependence treatment products through Pinney Associates to GlaxoSmithKline Consumer HealthCare. JEH also has a financial interest in a new nicotine replacement product. JEH was supported in part by the Robert Wood Johnson Foundation Innovators Awards Program at the Johns Hopkins University School of Medicine. Additional support to JEH, RVF, and ARB was provided by Pinney Associates.

  • This article is available online at http://CAonline.AmCancerSoc.org

Abstract

Approximately 50% of long-term cigarette smokers die prematurely from the adverse effects of smoking, including on cancer, cardiovascular disease, lung disease, or other illness. This risk can be substantially reduced by smoking cessation, with greater benefits occurring the earlier in the smoking career that cessation occurs. However, cessation provides benefits at any stage, including after the onset of smoking-related disease, by improving the prognosis and quality of life. Clinicians can have a significant impact on reducing tobacco use by their patients by following the US Public Health Service Clinical Practice Guidelines. Proven strategies include structured methods of advising cigarette smokers to quit and guidance to facilitate their efforts, as well as the use of various pharmacotherapies. Pharmacotherapies for tobacco dependence include nicotine replacement medications in the form of gum, transdermal patch, lozenge, sublingual tablet, nasal spray, and vapor inhaler formulations. The only nonnicotine medication that has been approved by the US Food and Drug Administration is bupropion. Combination therapies, long-term medication therapies, and harm reduction strategies may further improve outcome with approved medications. Further, new medications such as varenicline and rimonabant are likely to reach tobacco users who are refractory to current treatments. Increasing the treatment options, increasing availability, and reducing the perceived cost of these medications may have an additional public health impact.

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