CNS Drugs

, Volume 16, Issue 10, pp 653–662 | Cite as

Pharmacotherapy for Treating Tobacco Dependence

What is the Ideal Duration of Therapy?
  • Tammy Harris SimsEmail author
  • Michael C. Fiore
Current Opinion


Various forms of nicotine replacement therapy and bupropion have been found to be efficacious and well tolerated for treating patients dependent on tobacco. However, the currently recommended duration of treatment with pharmacotherapy may be insufficient for some smokers to achieve sustained abstinence from tobacco. Extending the use of pharmacotherapy beyond the recommended timeframe may be an effective strategy for helping tobacco users achieve abstinence and for preventing relapse to tobacco use, especially among those who are highly dependent and those who are concerned about body weight gain following cessation.

Several studies have reported on long-term use of various pharmacotherapies. These studies have demonstrated that such long-term use is not harmful. Moreover, compared with continued smoking, long-term use of pharmacotherapy exposes patients to relatively small amounts of nicotine and none of the cancer-causing chemicals found in cigarettes and other tobacco products. However, more research is needed to further clarify questions regarding the ideal duration of therapy. Two questions have yet to be answered: In what populations of smokers is long-term therapy an effective strategy for achieving abstinence and preventing relapse? Does wider availability of nicotine replacement therapy lead to initiation of nicotine addiction by children and others not using tobacco products? Also, as with all medications, additional documentation of the safety of prolonged use of pharmacotherapy is important.

The aim of this review is to present the current evidence supporting the notion that long-term therapy for treating tobacco dependence may be appropriately considered for some tobacco users.


Nicotine Smoking Cessation Bupropion Withdrawal Symptom Nicotine Replacement Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This research was supported in part by the National Cancer Institute P50-CA84724 centre grant and minority supplements.


  1. 1.
    Lichenstein E, Glasgow RE, Abrams DB. Social support in smoking cessation: in search of effective interventions. Behav Ther 1986; 17(5): 607–19CrossRefGoogle Scholar
  2. 2.
    Murray RP, Voelker HT, Rakos RF, et al. Intervention for relapse to smoking: the Lung Health Study restart programs. Addict Behav 1997; 22(2): 281–6PubMedCrossRefGoogle Scholar
  3. 3.
    Benowitz NL. Nicotine replacement therapy: what has been accomplishedcan we do better? Drugs 1993; 45(2): 157–70PubMedCrossRefGoogle Scholar
  4. 4.
    Fagerstrom KO. Nicotine replacement: present and future. CVD Prev 1999 Jun; 2(2): 145–9Google Scholar
  5. 5.
    Hughes JR, Higgins ST, Bickel WK. Common errors in the pharmacologic treatment of drug dependence and withdrawal. Compr Ther 1994; 20(2): 89–94PubMedGoogle Scholar
  6. 6.
    Henningfield JE. Nicotine medications for smoking cessation. N Engl J Med 1995 Nov; 333(18): 1196–203PubMedCrossRefGoogle Scholar
  7. 7.
    Physicians’ Desk Reference. 56th ed. Montvale (NJ): Medical Economics Company, Inc., 2002Google Scholar
  8. 8.
    Fiore MC, Bailey WC, Cohen SJ, et al. Treating tobacco use and dependence: clinical practice guideline. Rockville (MD): US Department of Health and Human Services Public Health Service, 2000 JunGoogle Scholar
  9. 9.
    Holm KJ, Spencer CM. Bupropion: a review of its use in the management of smoking cessation. Drugs 2000 Apr; 59(4): 1007–24PubMedCrossRefGoogle Scholar
  10. 10.
    Brigham J, Henningfield JE, Stitzer ML. Smoking relapse: a review. Int J Addict 1991; 25 (9A, 10A): 1239–55Google Scholar
  11. 11.
    Piasecki TM, Fiore MC, Baker TB. Profiles in discouragement: two studies of variability in the time course of smoking withdrawal symptoms. J Abnorm Psychol 1998; 107(2): 238–51PubMedCrossRefGoogle Scholar
  12. 12.
    Piasecki TM, Niaura R, Shadel WG, et al. Smoking withdrawal dynamics in unaided quitters. J Abnorm Psychol 2000; 109(1): 74–86PubMedCrossRefGoogle Scholar
  13. 13.
    West R, Hajek P, Foulds J, et al. A comparison of the abuse liability and dependence potential of nicotine patch, gum, spray and inhaler. Psychopharmocology (Berl) 2000 Jan; 149: 198–202CrossRefGoogle Scholar
  14. 14.
    Hjalmarson A, Franzon M, Westin A, et al. Effect of nicotine nasal spray on smoking cessation: a randomized, placebo-controlled, double-blind study. Arch Intern Med 1994; 154: 2567–72PubMedCrossRefGoogle Scholar
  15. 15.
    Bohadana A, Nilsson F, Rasmussen T, et al. Nicotine inhaler and nicotine patch as a combination therapy for smoking cessation: a randomized, double-blind, placebo-controlled trial. Arch Intern Med 2000; 160: 3128–34PubMedCrossRefGoogle Scholar
  16. 16.
    Hughes JR. Dependence on and abuse of nicotine replacement medications: an update. In: Benowitz NL, editor. Nicotine safety and toxicity. New York: Oxford University Press, 1998: 147–57Google Scholar
  17. 17.
    Hughes JR. Dependence potential and abuse liability of nicotine replacement therapies. Prog Clin Biol Res 1988; 261: 261–77PubMedGoogle Scholar
  18. 18.
    Hughes JR, Hatsukami DK, Skoog KP. Physical dependence on nicotine in gum: a placebo substitution trial. JAMA 1986; 255: 3277–9PubMedCrossRefGoogle Scholar
  19. 19.
    West JR, Russell MA. Effects of withdrawal from long-term nicotine gum use. Psychol Med 1985; 15: 891–3PubMedCrossRefGoogle Scholar
  20. 20.
    Hughes JR, Gust SW, Keenan RM, et al. Long-term use of nicotine versus placebo gum. Arch Intern Med 1991 Oct; 151: 1993–8PubMedCrossRefGoogle Scholar
  21. 21.
    Hughes JR, Wadland WC, Fenwick JW, et al. Effect of cost on the self-administration and efficacy of nicotine gum: a preliminary study. Prevent Med 1991; 20: 486–96CrossRefGoogle Scholar
  22. 22.
    Sutherland G, Stapleton JA, Russell MA, et al. Randomised controlled trial of nasal nicotine spray in smoking cessation. Lancet 1992 Aug; 340: 324–9PubMedCrossRefGoogle Scholar
  23. 23.
    Murray RP, Daniels K. Long-term nicotine therapy. In: Benowitz NL, editor. Nicotine safety and toxicity. New York: Oxford University Press, 1998: 173–82Google Scholar
  24. 24.
    Nides MA, Gonzales D, Tashkin DP, et al. Predictors of initial smoking cessation and relapse through the first 2 years of the Lung Health Study. J Consult Clin Psychol 1995; 63(1): 60–9PubMedCrossRefGoogle Scholar
  25. 25.
    Murray RP, Gerald LB, Lindgren PG, et al. Characteristics of participants who stop smoking and sustain abstinence for 1 and 5 years in the Lung Health Study. Prevent Med 2000; 30: 392–400CrossRefGoogle Scholar
  26. 26.
    Hajek P, Jackson P, Belcher M. Long-term use of nicotine chewing gum: occurrence, determinants, and effect on weight gain. JAMA 1988 Sep; 260(11): 1593–6PubMedCrossRefGoogle Scholar
  27. 27.
    Fiore MC, Smith SS, Jorenby DE, et al. The effectiveness of the nicotine patch for smoking cessation: a meta-analysis. JAMA 1994 Jun; 271(24): 1940–7PubMedCrossRefGoogle Scholar
  28. 28.
    Tønnesen P, Paoletti P, Gustavsson G, et al. Higher dosage nicotine patches increase one-year smoking cessation rates: results from the European CEASE trial. Eur Resp J 1999; 13: 238–46CrossRefGoogle Scholar
  29. 29.
    Stapleton JA, Sutherland G, Russell MA. How much does relapse after one year erode effectiveness of smoking cessation treatments? Long term follow up of randomised trial of nicotine nasal spray. BMJ 1998 Mar; 316(7134): 830–1PubMedCrossRefGoogle Scholar
  30. 30.
    Hays JT, Hurt RD, Rigotti NA, et al. Sustained-release bupropion for pharmacologic relapse prevention after smoking cessation. Ann Intern Med 2001 Sep; 135(6): 423–33PubMedGoogle Scholar
  31. 31.
    Murray RP, Bailey WC, Daniels K, et al. Safety of nicotine polacrilex gum used by 3,094 participants in the Lung Health Study: Lung Health Study Research Group. Chest 1996 Feb; 109: 438–45PubMedCrossRefGoogle Scholar
  32. 32.
    Hurt RD, Offord KP, Lauger GG, et al. Cessation of long-term nicotine gum use: a prospective, randomized trial. Addiction 1995; 90: 407–13PubMedCrossRefGoogle Scholar
  33. 33.
    Hatsukami D, Huber M, Callies A, et al. Physical dependence on nicotine gum: effect of duration of use. Psychopharmacology (Berl) 1993; 111(4): 449–56CrossRefGoogle Scholar
  34. 34.
    Stratton K, Shetty P, Wallace R, et al. Clearing the smoke: assessing the science base for tobacco harm reduction: Institute of Medicine. Washington, DC: National Academy Press, 2001Google Scholar
  35. 35.
    Hurt RD. Clinical implications of long-term nicotine use. In: Ferrence R, Slade J, Room R, et al., editors. Nicotine and public health: the American Public Health Association. Washington, DC: United Book Press, 2000: 389–428Google Scholar
  36. 36.
    Schuh KJ, Schuh LM, Henningfield JE, et al. Nicotine nasal spray and vapor inhaler: abuse liability assessment. Psychopharmacology (Berl) 1997; 130: 352–61CrossRefGoogle Scholar
  37. 37.
    Russell MA. The future of nicotine replacement. Br J Addict 1991; 86: 653–8PubMedCrossRefGoogle Scholar
  38. 38.
    Warner KE, Slade J, Sweaner DT. The emerging market for long-term nicotine maintenance. JAMA 1997 Oct; 278(13): 1087–92PubMedCrossRefGoogle Scholar
  39. 39.
    McNeill A, Foulds J, Bates C. Regulation of nicotine replacement therapies (NRT): a critique of current practice. Addiction 2001; 96: 1757–68PubMedCrossRefGoogle Scholar
  40. 40.
    National Center for Tobacco-Free Kids: petition for Food and Drug Administration regulation of Activa tobacco lozenges [online]. Available from URL: [Accessed 2002 Jul 16]
  41. 41.
    Henningfield JE. Tobacco dependence treatment: scientific challenges, public health opportunities. Tob Control 2000; 9Suppl. I: i3–i10PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of Wisconsin Medical School, Center for Tobacco Research and InterventionMadisonUSA
  2. 2.Division of General Internal Medicine, Department of Medicine, Center for Tobacco Research and InterventionUniversity of Wisconsin Medical SchoolMadisonUSA

Personalised recommendations