Smoking Cessation Interventions

Smoking Cessation Interventions; Pharmacological Aids

Sedation, dry mouth and lightheadedness are common side effects affecting at least half of users ⁽¹⁾. Extreme caution is advised if used in patients with cardiovascular disease due to risk of arrhythmias, changes in contractility and blood flow. Nortriptyline is an efficacious smoking cessation treatment. It may be used under a doctor's supervision as a second line agent to treat tobacco dependence ⁽¹⁵⁾. When used for smoking cessation treatment is initiated two to four weeks before the quit date and continued for around 12 weeks⁽¹⁾. Fluoxetine; is a potent and selective inhibitor of neuronal serotonin reuptake. It is sold as Prozac . Fluoxetine reduces food intake and increases resting energy expenditure, resulting in moderate body weight loss during use ⁽¹⁶⁾ and reduction of weight gain in smoking cessation ⁽¹⁷⁾ . Use of fluoxetine significantly increased abstinence rate from 20% in the placebo to 30% in two treatment groups at six months follow-up in a multi-centre trial ⁽¹⁸⁾. Fluoxetine, compared to placebo, increased the likelihood of abstinence at one and three months amongst smokers with minor depression but not those with little or no depression ⁽¹⁹⁾. Fluoxetine was used in conjunction with cognitive-behavioural therapy. When used for smoking cessation, treatment is initiated two weeks before the target quit date and is generally continued for at least three months. Fluoxetine may aid smoking cessation in depressed smokers ⁽¹⁹⁾.		Other pharmacological aids Clonidine is a centrally acting adrenergic agonist that dampens sympathetic nervous system activity. The main rationale for use is to reduce tobacco withdrawal symptoms, especially craving. It is used primarily as an antihypertensive medication. It may be administered transdermally or orally. Smokers using clonidine are started on the drug several days before quitting and maintained on a fixed daily dose for several weeks. The usefulness of clonidine is limited by appreciable sedation and postural hypotension ⁽²⁰⁾. Local skin irritation is common with transdermal clonidine. Adverse effects if ceased abruptly include nervousness, agitation, headache and tremor, accompanied by a rapid rise in blood pressure and elevated catecholamine levels. Mecamylamine is a nicotine antagonist. The rationale for use is its potential to block the rewarding effect of nicotine, therefore reducing smoking.No evidence for its effect on smoking cessation if used alone, but in combination with nicotine, it may be superior to nicotine alone ⁽²¹⁾. Naltrexone is a long acting opioid antagonist. In humans, smoking one or two cigarettes significantly increases plasma endorphin levels, leading to the theory that endogenous endorphins may reinforce smoking behaviour ⁽²²⁾. Clinical trials failed to detect a significant difference in quit rates between naltrexone and placebo⁽²³⁾. Anxiolytics; they increase production of dopamine, serotonin and norepinephrine, low levels of which are associated with urge to smoke and the anxiety that occurs with nicotine withdrawal .There is no consistent evidence that anoxiolytics aid smoking cessation ⁽²⁴⁾.

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