Abstract
As a reflection of an exponential increase in smoking rates throughout the world during the last century, the economic and human burden of mortality and morbidity related to smoking is now clearly defined. Smoking cessation is associated with health benefits for people of all ages. In this paper we provide a comprehensive review of current licensed pharmacological smoking cessation agents including efficacy and safety profiles, with comparisons of individual therapies available. Furthermore, we offer a prospective on the need for further testing of other agents including novel avenues of therapy.
Similar content being viewed by others
References
Mason RJ, Buist AS, Fisher EB, Merchant JA, Samet JM, Welsh CH. Cigarette smoking and health. Am Rev Respir Dis. 1985;132:1133–1136.
Centers for Disease Control and Prevention. Sample adult core component of the 1997-2006 National Health Interview Survey. Available at: http://www.cdc.gov/nchs/data/hus/hus08pdf#063. Accessed March 4, 2009.
American Thoracic Society. Cigarette smoking and health. Am J Respir Crit Care Med. 1996;153:861–865.
Ezatti M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet. 2003;362:847–852.
Centers for Disease Control and Prevention (CDC). Tobacco use — United States, 1900–1999. MMWR Morb Mortal Wkly Rep. 1999;48:986–993.
Centers for Disease Control and Prevention (CDC). Annual smoking attributable mortality, years of potential life lost, and economic costs - United States, 1995-1999. MMWR Morb Mortal Wkly Rep. 2002;51:300–303.
Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43–66.
Scanlon PD, Connett JE, Waller LA, Altose MD, Bailey WC, Buist AS. Smoking cessation in mild to moderate chronic obstructive pulmonary disease. The Lung Health Study. Am J Respir Crit Care Med. 2000;161:381–390.
Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA: National Center of Chronic Disease Prevention and Health Promotion; 2004.
Ezzati M, Henley SJ, Thun MJ, Lopez AD. Role of smoking in global and regional cardiovascular mortality. Circulation. 2005;112:489–497.
Godtfredsen NS, Holst C, Prescott E, et al. Smoking reduction, smoking cessation, and mortality: a 16 year follow up of 19,732 men and women from the Copenhagen centre for prospective population studies. Am J Epidemiol. 2002;156:994–1001.
Samet JM. The health benefits of smoking cessation. Med Clin North Am. 1992;76:399–414.
Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of inhaled anticholinergic bronchodilators on the rate of decline of FEV1. JAMA. 1994;272:1497–1505.
US Department of Health and Human Services. The health benefits of smoking cessation. A report of the Surgeon General, 1990. DHHS Publication No. (CDC) 90-8416. Rockville, MD: US Public Health Services, Office on Smoking and Health; 1990.
Taylor DH Jr, Hassalblad V, Henley SJ, Thun MJ, Sloan FA. Benefits of smoking cessation for longevity. Am J Public Health. 2002;92:990–996.
Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. A clinical practice guideline for treating tobacco use and dependence: a US Public Health Service report. JAMA. 2000;283:3244–3254.
Anderson JE, Jorenby DE, Scott WJ, Fiore MC. Treating tobacco use and dependence: an evidencebased clinical practice guideline for tobacco cessation. Chest. 2002;121:932–941.
Rigotti NA. Treatment of tobacco use and dependence. N Engl J Med. 2002;346:506–512.
US Preventive Services Task Force. Counseling to prevent tobacco use and tobacco-caused disease: recommendation statement. Rockville, MD: Agency for Healthcare Research and Quality; 2003.
Office of the US Surgeon General. The health consequences of smoking: nicotine addiction: a report of the Surgeon General. DHHS Publication No. (CDC) 88-8406. Atlanta, GA: Centers for Health Promotion and Education, Office on Smoking and Health; 1988.
Henningfield JE, Stapelton JM, Benowitz NI, Grayson RF, London ED. Higher levels of nicotine in arterial than in venous blood after cigarette smoking. Drug Alcohol Depend. 1993;33:23–29.
Watkins SS, Koob GF, Markou A. Neural mechanisms underlying nicotine addiction: acute positive reinforcement and withdrawal. Nicotine Tob Res. 2000;2:19–37.
Hughes JR. Effects of abstinence from tobacco: valid symptoms and time course. Nicotine Tob Res. 2007;9:315–327.
Fiore MC, Jaen CR, Baker TB, et al. Clinical practice guideline: treating tobacco use and dependence 2008 update. Rockville, MD: Department of Health and Human Services; 2008.
Okuyeni KS, Ahluwalia JS, Harris KJ. Pharmacotherapy of smoking cessation. Arch Fam Med. 2000;9:270–281.
Molyneux A. Nicotine replacement therapy. BMJ. 2004;328:454–456.
Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2004;(3):CD000146.
Lam W, Sze PC, Sacks HS, Chalmers TC. Metaanalysis of randomised controlled trials of nicotine chewing-gum. Lancet. 1987;2:27–30.
Schneider NG, Lunell E, Olmstead RE, Fagerström KO. Clinical pharmacokinetics of nasal nicotine delivery. A review and comparison to other nicotine systems. Clin Pharmacokinet. 1996;31:65–80.
Fiore MC, Smith SS, Jorenby DE, Baker TB. The effectiveness of the nicotine patch for smoking cessation. A meta-analysis. JAMA. 1994;271:1940–1947.
Schneider NG, Olmstead R, Mody FV, et al. Efficacy of a nicotine nasal spray in smoking cessation: a placebo-controlled, double-blind trial. Addiction. 1995;90:1671–1682.
Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2008;(1):CD000146.
Hajek R, West R, Foulds J, Nilsson F, Burrows S, Meadow A. Randomized comparative trial of nicotine polacrilex, a transdermal patch, nasal spray, and an inhaler. Arch Intern Med. 2000;159;2033–2038.
Bohadana A, Nilsson F, Rasmussen T, Martinet Y. Nicotine inhaler and nicotine patch as a combination therapy for smoking cessation: a randomized, double-blind, placebo controlled trial. Arch Intern Med. 2000;160:3128–3134.
Benowitz NL, Steven GG. Cardiovascular toxicity of nicotine: implication for nicotine replacement therapy. J Am Coll Cardiol. 1997;7:1422–1437.
Dempsey DA, Benowitz NL. Risks and benefits of nicotine to aid smoking cessation in pregnancy. Drug Saf. 2001;24:277–322.
Coleman T, Britton J, Thornton J. Nicotine replacement therapy in pregnancy. BMJ. 2004;328;965–966.
Rose JE. Nicotine and nonnicotine factors in cigarette addiction. Psychopharmacology (Berl). 2006;184:274–285.
Balfour DJ. The pharmacology underlying pharmacotherapy for tobacco dependence: a focus on bupropion. Int J Clin Pract. 2001;55:53–57.
Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2007;(1):CD000031.
Ascher JA, Cole JO, Colin JN, et al. Bupropion: a review of its mechanism of antidepressant activity. J Clin Psychiatry. 1995;56:395–401.
Cryan JF, Dalvi A, Jin SH, Hirsch BR, Lucki I, Thomas SA. Use of dopamine-beta-hydroxylase-deficient mice to determine the role of norepinephrine in the mechanism of action of antidepressant drugs. J Pharmacol Exp Ther. 2001;298:651–657.
Meyer JH, Goulding VS, Wilson AA, Hussey D, Christensen BK, Houle S. Bupropion occupancy of the dopamine transporter is low during clinical treatment. Psychopharmacology. 2002;163:102–105.
Semmer JE, Martin BR, Damaj MI. Bupropion is a nicotinic antagonist. J Pharmacol Exp Ther. 2000;295:321–327.
Hurt RD, Sachs DPL, Glover ED, et al. A comparison of slow release buproprion and placebo for smoking cessation. N Engl J Med. 1997;337:1195–1202.
Swan GE, McAfee T, Curry SJ, et al. Effectiveness of bupropion sustained release for smoking cessation in a health care setting: a randomized trial. Arch Intern Med. 2003;163:2337–2344.
Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med. 1999;340:685–691.
Fiore MC, Bailey WC, Cohen SJ et al. Treating tobacco use and dependence. Rockville, MD: Department of Health and Human Services, Public Health Service; 2000.
Wilkes S. The use of bupropion SR in cigarette smoking cessation. Int J Chron Ostruct Pulmon Dis. 2008;3:45–53.
Slater YE, Houlihan LM, Maskell PD et al. Halogenated cytosine derivatives as agonists at human neuronal nicotinic acetylcholine receptor subtypes. Neuropharmacology. 2003;44:503–515.
Coe JW, Brooks PR, Vetelino MG, et al. Varenicline: an alpha4beta2 nicotinic receptor partial agonist for smoking cessation. J Med Chem. 2005;48:3474–3477.
Aveyard P, West R. Managing smoking cessation. BMJ. 2007;335:37–41.
Jorenby DE, Hays JT, Rigotti NA, et al. Varenicline Phase 3 Study Group. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. JAMA. 2006;296:56–63.
Tonstad S, Tonnensen P, Hajek P, Williams KE, Billing CB, Reeves KR. Varenicline Phase 3 Study Group. Effects of maintenance therapy with varenicline on smoking cessation: a randomized controlled trial. JAMA. 2006;296:64–71.
Gonzales D, Rennard SI, Nides M, et al. Varenicline Phase 3 Study Group. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist vs sustained release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA. 2006;296:47–55.
Eisenberg MJ, Filion KB, Yavin D, et al. Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. CMAJ. 2008;179:135–144.
Stapleton JA, Watson L, Spirling LI, et al. Varenicline in the routine treatment of tobacco dependence: a pre-post comparison with nicotine replacement therapy and an evaluation in those with mental illness. Addiction. 2008;103:146–154.
Aubin HJ, Bobak A, Britton JR, et al. Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open-label trial. Thorax. 2008;63:717–724.
Hays JT, Ebbert JO. Varenicline for tobacco dependence. N Engl J Med. 2008;359:2018–2024.
US Drug and Food Administration, Center for Drug Evaluation and Research. Varenicline [marketed as Chantix] information. Washington, DC: US Department of Health and Human Services; 2008.
Obach RS, Reed-Hagen AE, Krueger SS, et al. Metabolism and disposition of varenicline, a selective alpha4beta2 acetylcholine receptor partial agonist, in vivo and in vitro. Drug Metab Dispos. 2006;34:121–130.
Etter JF. Cytisine for smoking cessation: a literature review and a meta-analysis. Arch Intern Med. 2006;166:1553–1559.
Gourlay SG, Stead LF, Benowitz NL. Clonidine for smoking cessation. Cochrane Database Syst Rev. 2004;(3):CD000058.
Johnson BA, Ait-Daoud N, Akhtar FZ, Javors MA. Use of oral topiramate to promote smoking abstinence among alcohol-dependent smokers: a randomized controlled trial. Arch Intern Med. 2005;165:1600–1605.
George TP, Vessicchio JC, Termine A, Jatlow PI, Kosten TR, O’Malley SS. A preliminary placebocontrolled trial of selegiline hydrochloride for smoking cessation. Biol Psychiatry. 2003;53:136–143.
Jarvik ME, Caskey NH, Wirshing WC, et al. Bromocriptine reduces cigarette smoking. Addiction. 2000;95:1173–1183.
Cahill K, Ussher M. Cannabinoid type 1 receptor antagonists (rimonabant) for smoking cessation. Cochrane Database Syst Rev. 2007;(4):CD005353.
Cryan JF, Gasparini F, van Heeke G, Markou A. Non-nicotinic neuropharmacological strategies for nicotine dependence: beyond bupropion. Drug Discov Today. 2003;8:1025–1034.
Cornuz J, Zwahlen S, Jungi WF, et al. A vaccine against nicotine for smoking cessation: a randomized controlled trial. PLoS ONE. 2008;3:e2547.
Law M, Tang JL. An analysis of the effectiveness of interventions intended to help people stop smoking. Arch Intern Med. 1995;155:1933–1941.
Rigotti NA, Munafo MR, Stead LF. Smoking cessation interventions for hospitalized smokers: a systematic review. Arch Intern Med. 2008;168:1950–1960.
Stratelis G, Mölstad S, Jakobsson P, Zetterström O. The impact of repeated spirometry and smoking cessation advice on smokers with mild COPD. Scand J Prim Health Care. 2006;24:133–139.
Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years observation on male British doctors. BMJ. 2004;328:1519.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Glynn, D.A., Cryan, J.F., Kent, P. et al. Update on smoking cessation therapies. Adv Therapy 26, 369–382 (2009). https://doi.org/10.1007/s12325-009-0022-9
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12325-009-0022-9