Tobacco

Pharmacology

  • xxx

Adverse Effects

Cardiac Adverse Effects

Hematologic Adverse Effects

Pulmonary Adverse Effects

Renal Adverse Effects

  • xxxx

Gastroenterologic Adverse Effects


Treatment of Tobacco Addiction

Bupropion (Wellbutrin, Zyban) (see Bupropion, [[Bupropion]])

  • Pharmacology: non-SSRI and non-TCA norepinephrine-dopamine reuptake inhibitor
  • Clinical Efficacy: xxx

Nicotine Replacement (see Nicotine, [[Nicotine]])

  • Pharmacology
  • Clinical Efficacy: xxx

Varenicline (Chantix) (see Varenicline, [[Varenicline]])

  • Phamracology: partial nicotine receptor agonist
  • Clinical Efficacy: more effective than either nicotine replacement or bupropion
  • Technique
    • Variable Quit Date Strategy: effective [MEDLINE]
  • Adverse Effects

Cytisine (see Cytisine, [[Cytisine]])

  • Pharmacology: partial agonist of α4β2 nicotinic acetylcholine receptor (similar to varenicline)
  • Clinical Efficacy
    • Systematic Review/Meta-Analysis of Cytisine in Tobacco Cessation (2013) [MEDLINE]: cytisine is an effective treatment for smoking cessation with efficacy comparable to that of other currently licensed treatments
    • Australian New Zealand Clinical Trials Group Open Label, Non-Inferiority Trial Comparing Cytisine to Nicotine Replacement (2014) [MEDLINE]: when combined with brief behavioral support, cytisine was superior to nicotine-replacement therapy in helping smokers quit smoking at 1 mo/2 mo/6 mo
      • Cytisine was associated with a higher frequency of self-reported adverse events (predominantly nausea/vomiting and sleep disorders): however, only 5% of the cytisine subjects discontinued the treatment
      • Many of the subjects in this study had previously tried nicotine replacement therapy, and all the participants received vouchers for lower cost nicotine replacement: in the cytisine group, 4% used the nicotine replacement vouchers

References

  • Placebo-controlled trial of cytisine for smoking cessation. N Engl J Med 2011;365:1193-1200 [MEDLINE]
  • Risk of serious adverse cardiovascular events associated with varenicline: a systematic review and meta-analysis. CMAJ 2011;183(12): 1359-1366 [MEDLINE]
  • Risk of cardiovascular serious adverse events associated with varenicline use for tobacco cessation: systematic review and meta-analysis. BMJ 2012; 344:e2856 [MEDLINE]
  • A randomized placebo-controlled trial of varenicline for smoking cessation allowing flexible quit dates. Nicotine Tob Res 2012;14:343-350 [MEDLINE]
  • Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2012;4:CD006103 [MEDLINE]
  • Efficacy of cytisine in helping smokers quit: systematic review and meta-analysis. Thorax 2013;68:1037-1042 [MEDLINE]
  • Cytisine versus nicotine for smoking cessation. N Engl J Med 2014;371:2353-2362 [MEDLINE]
  • Cytisine—a tobacco treatment hiding in plain sight. N Engl J Med 2014;371:2420-2421 [MEDLINE]