Combination nicotine replacement therapy for smoking cessation: Rationale, efficacy and tolerability

Combination nicotine replacement therapy for smoking cessation: Rationale, efficacy and tolerability

Currently available nicotine replacement therapy (NRT) medications provide effective treatment for tobacco dependence, typically doubling success rates compared with placebo. A strategy for further improving the efficacy of NRT is to combine one medication that allows for passive nicotine delivery (...

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Bibliographic Details
Published in:CNS drugs Vol. 15; no. 6; pp. 453 - 467
Main Authors: SWEENEY, Christine T, FANT, Reginald V, FAGERSTROM, Karl O, MCGOVERN, Joseph F, HENNINGFIELD, Jack E
Format: Journal Article
Language:English
Published: Hong Kong Adis International 2001
Auckland
Subjects:
Biological and medical sciences
Humans
Medical sciences
Nicotine - administration & dosage
Nicotine - adverse effects
Nicotine - therapeutic use
Nicotinic Agonists - administration & dosage
Nicotinic Agonists - adverse effects
Nicotinic Agonists - therapeutic use
Smoking - physiopathology
Smoking - psychology
Smoking Cessation - legislation & jurisprudence
Smoking Cessation - methods
Tobacco, tobacco smoking
Toxicology
Human
Delivery system
Pharmacogenetics
Replacement therapy
Toxicity
Detoxification
Tobacco smoking
Review
Long term
Biological activity
Alkaloid
Chemotherapy
Toxicogenetics
Dependence
Withdrawal syndrome
Nicotine
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Summary:Currently available nicotine replacement therapy (NRT) medications provide effective treatment for tobacco dependence, typically doubling success rates compared with placebo. A strategy for further improving the efficacy of NRT is to combine one medication that allows for passive nicotine delivery (e.g. transdermal patch) with another medication that permits ad libitum nicotine delivery (e.g. gum, nasal spray, inhaler). The rationale for combining NRT medications is that smokers may need both a slow delivery system to achieve a constant concentration of nicotine to relieve cravings and tobacco withdrawal symptoms, as well as a faster acting preparation that can be administered on demand for immediate relief of breakthrough cravings and withdrawal symptoms. This article reviews 5 published studies that have examined the effectiveness of combination NRT compared with monotherapy in providing withdrawal relief and smoking cessation, and examines other factors relevant to the promotion of combination NRT for treating tobacco dependence. The data show that there are conditions under which combinations of NRT products provide greater efficacy in relieving withdrawal and enabling cessation than monotherapy, but the findings are not robust and additional research is warranted to better understand the magnitude and generality of the benefits of combination therapy. There are also regulatory and commercial obstacles that must be considered. Nonetheless, combination NRT has the potential to provide effective treatment of tobacco dependence in persons whose dependence is refractory to currently available treatments.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
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ObjectType-Review-1
ISSN:1172-7047
1179-1934
DOI:10.2165/00023210-200115060-00004