DRUG THERAPY TO AID IN SMOKING CESSATION

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DRUG THERAPY TO AID IN SMOKING CESSATION

Authors: Shreesha V. Bhat , Ayush A. Singhal,
College: Ramanbhai Patel College of Pharmacy

Nineteenth century humorist Josh Billings may have had smoking in mind when he observed that the vices a
person contracts in youth, however much that person may try to shake them off, often call again through life
and seek to renew acquaintance. Smoking is certainly one the most difficult practices to shake off and one of
the most persistent in making return visits.

Current approaches to smoking cessation recognize that cigarette smoking is not a simple habit but, rather, is
a complex physiologic addiction. The most important active compound in cigarette smoke contributing to
addiction is nicotine.

Nicotine is clearly an addicting substance. Nicotine withdrawal is associated with a well-described
syndrome characterized by irritability, awakening from sleep, bradycardia, anxiety, impaired concentration,
impaired reaction time, restlessness, drowsiness, impotence, confusion, hunger, weight gain, and, consistent
with nicotine’s actions as an antidepressant, with depression.

Smoking cessation efforts fit into two broad categories: pharmacologic and behavioral. Pharmacologic
approaches currently include two general strategies: nicotine replacement and bupropion therapy.

Although 70 percent of patients who smoke say they would like to quit, only 7.9 percent are able to do so
without help. The advice of a physician alone can improve the smoking cessation rate to 10.2 percent. The
combined use of nicotine replacement, bupropion (Zyban), and social or behavioral support can increase the
quit rate to 35 percent.

Nicotine replacement by any delivery system has been shown to double the smoking cessation rate.
Currently, four forms of nicotine delivery are available:
 Nicotine Patch
 Nicotine Gum
 Nicotine Inhaler
 Nicotine Nasal spray Use of a combination of delivery methods, such as the gum and the patch, may be useful in heavily
nicotine-dependent smokers. Nicotine is the addictive substance in tobacco products. NRT provides nicotine
in a safe form so the body doesn't have to endure nicotine withdrawal while a person adapts to not smoking.

NRT is most tried and tested treatment. Over 100 placebo controlled randomized Studies, involving
over 30,000 smokers have been conducted, and the results have been more than satisfactory.

The success of NRT lies in the fact that nicotine alone is not responsible for cancer. Other tobacco
smoke constituents are believed to be responsible for cancers. Studies carried out in rodents demonstrate that
under normal conditions nicotine is not carcinogenic.

Bupropion:
Bupropion is an antidepressant, active on dopaminergic pathways in the CNS. Bupropion has been
approved as smoking cessation aid . In one of the clinical trials, bupropion was combined with nicotine
replacement therapy via a transdermal system, and the combination had the highest quit rates.

Varenicline:
Varenicline (Champix) is a new class of smoking cessation therapy. It has a favourable safety and
tolerability profile.It has dual activity:-

-Partial agonist action: reduces craving and withdrawal symptoms.
-Antagonist action: reduces the reinforcing effects of smoking.
CONCLUSION:
Currently available smoking-cessation methodologies can assist a significant majority of smokers in
quitting. The currently available therapies, however, are appropriate for use in routine practice and can have
a positive impact on health outcomes.

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