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Smoking Cessation Medication

Gholamreza Heydari MD, MPH, PhD Director Tobacco Prevention and Control Research center Shahid Beheshti Medical University. Smoking Cessation Medication. Smokers die early. Pirie et al Lancet. 2013 Jan 12;381(9861):133-41. Quitting Works. Nicotine. Increase in dopamine. Binds to

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Smoking Cessation Medication

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  1. GholamrezaHeydari MD, MPH, PhD Director Tobacco Prevention and Control Research center ShahidBeheshti Medical University Smoking CessationMedication

  2. Smokers die early Pirie et al Lancet. 2013 Jan 12;381(9861):133-41

  3. Quitting Works

  4. Nicotine

  5. Increase in dopamine Binds to nACh receptors nicotine Mesolimbic dopamine pathway positive reinforcement

  6. Tobacco withdrawal syndrome

  7. The quitting process Individual and Environment Smoking Quit Attempt Abstinence Tobacco Control Policies Brief Interventions (e.g. AB+offer of C) Smoking Cessation Treatments Adapted from: Hughes Drug and alcohol dependence 117.2 (2011): 111-117.

  8. Remaining Quit Treatment • Behavioural support • Pharmacotherapy • Supportive environment

  9. Healthcare Professionals Role • Health care professionals can increase a patient’s odds of quitting with brief advice, medication, and behavioural support 1 • Tasks • Identifying people who smoke • Motivating a quit attempt • Refer for treatment and support • Supporting ongoing abstinence AVEYARD P. & WEST R (2007) Managing smoking cessation, BMJ, 335, 37-41.

  10. Advice from a Health Professional is the major external trigger Source: www.rjwest.co.uk - Smoking Toolkit Study

  11. Pharmacological Interventions for Smoking Cessation

  12. Nicotine replacement therapy Increase in dopamine Binds to nACh receptors Nicotine +++ Nicotine +

  13. Nicotine Delivery Source: Royal College of Physicians

  14. NRT: Long-term (>6 month) quit rates vs. placebo Pooled 150 studies RR=1.60 (95% CI: 1.53 - 1.68) Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub4.

  15. NRT - safety and side-effects • There are no ‘real’ contraindications to NRT • Some individual product differences e.g. gum not good for people with dentures • No drug interactions • The most common side effects are localised e.g. • Taste of oral products • Hiccups with the mouth spray • Skin irritation with patch

  16. Types of NRT • Gum • Lozenge • Microtab • Patch • Inhaler • Spry

  17. Bupropion • Atypical antidepressant which acts on dopamine and noradrenaline pathways and possibly as a nicotinic antagonist, designed to reduce motivation to smoke by • reducing cravings and withdrawal symptoms • reducing the rewarding effect of smoking What to say to your patients? Works by alleviating craving and other withdrawal symptoms It’s not a magic cure, but it will make quitting easier

  18. Bupropion: Long-term (>6 month) quit rates vs. placebo Pooled 36 studies RR=1.69 (95% CI:1.53-1.85) Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub3.

  19. Safety and side-effects • Side effects • Nausea (30%) – mostly well tolerated • Seizure

  20. Varenicline Varenicline = partial agonist of the 42 nAchR What to say to patients Varenicline works by reducing craving for cigarettes making quitting smoking a little easier and increases the chances of stopping for good. However it’s no magic cure and effort is still required.

  21. Varenicline: Long-term (>6 month) quit rates vs. placebo Pooled 14 studies RR=2.27 (95% CI 2.02 - 2.55) Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub6.

  22. Safety and side-effects • Side effects • Nausea (30%) – mostly well tolerated • Strange dreams and insomnia

  23. Long-term outcomes Source: New Zealand Guidelines for Helping People Stop Smoking

  24. National study on smoking cessation, Iran 2014

  25. Conclusion • Pharmacotherapy is effective but it is not magic • It must use with other supports • First line Champix, NRT, Zyban

  26. Visit our site: www.tpcrc.sbmu.ac.ir Quit line: 27122050-1 Email: heydari_gh@sbmu.ac.ir Thank you

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