戒烟药物研究进展

烟草依赖为一种慢性尼古丁成瘾性疾病.尼古丁强化效应是吸烟者戒烟失败的主要原因.吸烟者成功戒烟往往需戒烟药物的辅助治疗,常用戒烟药物有一线戒烟药物(如尼古丁替代、安非他酮及伐尼克兰)和二线戒烟药物(如可乐定和去甲替林等),以及其他戒烟药物.     

尼古丁依赖的药物治疗:指南与经验

吸烟是许多疾病的患病危险因素,戒烟可减少很多疾病的发病率及病死率,戒烟困难的原因在于尼古丁的成瘾性。尼古丁依赖是一种慢性高复发性疾病,属于精神神经疾病。有关戒烟指南指出针对戒烟者的尼古丁依赖鼓励使用戒烟药物。戒烟药物包括尼古丁替代药物,安非他酮及尼古丁乙酰胆碱受体α4β2亚型的选择性部分激动药(伐尼克兰),三类药物各有特点。伐尼克兰作为一种新型的戒烟药物,与尼古丁替代疗法(nicotine replacement therapy,NRT)存在不同的特点。我们比较了两者用于临床戒烟的有效性和不良反应,以期指导临床中不同特点戒烟者的尼古丁依赖的治疗。结果显示伐尼克兰应用和NRT都是安全有效的戒烟疗法,药物不良反应各有不同,临床工作中可根据戒烟者自身的不同特点进行相应的选择。     

可乐定贴片戒烟效果

目的 :观察可乐定贴片戒烟效果。方法 :自愿戒烟者 2 0人 ,随机、双盲分为 2组 ,每组各 10人。用药组于胸部贴可乐定贴片 2片 ( 2 .5mg/片 ) ,1wk更换 1次 ,连续 5wk ;安慰剂组 ,用空白贴片 ,其他完全相同。依据尿尼古丁代谢物 (可替宁 )及症状综合评价。结果 :2组吸烟量均显著减少 ,但可乐定贴片减轻焦虑、激惹等症状较明显。所用的可乐定剂量可使血压和心率稍有下降 ,但不影响继续用药。结论 :可乐定贴片可作为戒烟辅助药物     

新型戒烟药伐尼克兰有效性与安全性研究进展

伐尼克兰是一种口服的高选择性α4β2尼古丁乙酰胆碱受体部分激动/部分拮抗药，可以帮助吸烟者缓解戒断症状，减少对吸烟的渴求和满足感，是一种有效的戒烟药物。《美国烟草使用与依赖指南》最新版推荐该药为一线戒烟药物。Ⅱ期和Ⅲ期临床试验显示，伐尼克兰的戒断率高于安非他酮、尼古丁替代品和安慰药。大量的短期和延期治疗的临床试验证实，伐尼克兰具有很好的耐受性。该文就伐尼克兰的疗效、安全性及药物相互作用等方面进行综述。     

基因决定哪种戒烟法更有效

本刊讯 将来戒烟可能会更容易。研究人员首次发现了一种影响戒烟治疗效果的基因。美国杜克大学医学中心、美国全国药物滥用研究所、宾夕法尼亚大学和布朗大学的科学家通过对整个人类基因组进行扫描，搜寻能决定戒烟治疗效果的基因，发现了几种能预示尼古丁替换治疗（NRT）和安非拉酮治疗成功与否的遗传变异。     

反相高效液相色谱法测定复方戒烟贴片中尼古丁和可乐定的含量

目的 :建立反相高效液相色谱法检测复方戒烟贴片中尼古丁和可乐定的含量。方法 :用LichrosorbC8柱 ,甲醇 -磷酸盐缓冲液 (0 0 0 2 2mol·L- 1 磷酸二氢钾 - 0 0 16mol·L- 1 磷酸氢二钠溶液 ) (5 2∶48)为流动相 ,检测波长 2 6 8nm。结果 :该方法回收率尼古丁为 95 4% ,RSD为 3 8% (n =5 ) ;可乐定为 98 9% ,RSD为 4 8% (n =5 )。结论 :本法较简便 ,准确可靠 ,可作为复方戒烟贴片的质量控制方法。     

维拉帕米对偏头痛的防治效果

偏头痛的防治对偏头痛有预防效果的药物包括(1)β阻滞剂,如普萘洛尔、纳多洛尔、阿替洛尔和美托洛尔;(2)抗抑郁药,如阿米替林(Amitriptyline)、去甲替林(Nortriptyline)、丙米嗪(Impramine)、地昔帕明(Desipramine)和多塞平(Doxepin);(3)麦角制剂,如麦角胺和美西麦角(Methysergide);(4)非甾体抗炎药;(5)钙拮抗剂,如维拉帕米、硝苯啶、地尔硫革、氟桂嗪和尼莫地平等。传统疗法:防治偏头痛的传统用药为β阻滞剂、麦角制剂和抗抑郁药。β阻滞剂预     

国内一线慢性乙型肝炎治疗药物的优选

目的:探讨国内一线慢性乙型肝炎治疗药物的优选问题。方法:通过临床试验和相关指南,比较国内一线慢性乙型肝炎治疗药物之间的优劣。结果与结论:鉴于当前的循证医学证据以及国内药物的可获得性,依据安全、有效、经济的选药原则,普通干扰素和拉米夫定应当成为国内绝大部分慢性乙型肝炎患者的优选对象。     

尼古丁替代治疗制剂的新进展

过去20年里,国际上出现了多种类型的用于戒烟和尼古丁依赖治疗的尼古丁制剂,包括尼古丁透皮剂、尼古丁口胶剂、尼古丁喷剂和尼古丁舌下含片等.这些制剂在临床使用中有各自的优点,也有其局限性.现对近年国外研究出的新型尼古丁制剂的临床应用进行综述,以期提高现有的治疗水平.     

NICE发布戒烟治疗最新指南

英国国家健康和临床优化研究所（NICE）在最新公共健康指南中声明，应该向意向戒烟者提供Pfizer公司的Champix（varenicline）、GlaxoSmithKline公司的Zyban（bupropion）或者尼古丁替代治疗（比如尼古丁吸入剂）。     

Current and Emerging Pharmacotherapies for Cessation of Tobacco Smoking

Tobacco use disorder is a chronic illness. With its high comorbidity rate, it is a major cause of years of life lost or years lived with disability; however, it is also considered the most preventable cause of death in developed countries. Since the development of nicotine replacement therapy (NRT) in 1978, treatment options have continued to evolve and expand. Despite this, currently available treatments remain insufficient, with less than 25% of smokers remaining abstinent 1 year after treatment. In this article, we review existing and emerging smoking cessation pharmacotherapies, with a special emphasis on the most promising agents that are currently being investigated. A search of the Cochrane Database of Systematic Reviews and the PubMed, Ovid, and ClinicalTrials.gov databases (August 2 to September 1, 2017) was undertaken for articles on smoking cessation pharmacotherapies, applying no language restrictions. More than 40 pharmacotherapies were reviewed including conventional pharmacotherapies—NRT, bupropion, and varenicline (all approved by the U.S. Food and Drug Administration as first‐line treatment of smoking cessation)—and novel therapies: cytisine, N‐acetylcysteine, cycloserine, memantine, baclofen, topiramate, galantamine, and bromocriptine. Studies of combination NRT and varenicline showed the greatest smoking cessation rates. Clonidine and nortriptyline are second‐line treatments used when first‐line treatments fail or are contraindicated, or by patient preference. Some novel therapies, especially acetylcholinesterase inhibitors, cytisine, and N‐acetylcysteine, display promising results. Because the results of randomized clinical trials were reported using varied end points and outcome measures, direct comparisons between different pharmacotherapies cannot easily be evaluated. Additional high‐quality randomized double‐blind placebo‐controlled trials with long‐term follow‐up, using validated sustained abstinence measures, are needed to find more effective smoking cessation aids.     

Which is the best primary medication for long-term smoking cessation – nicotine replacement therapy,bupropion or varenicline?

Nicotine chewing gum has been available since 1982, when it was shown to increase smoking cessation rates by ～ 1.5- to 2-fold after 12 months. Despite the introduction of many other preparations of nicotine (sublingual, lozenge, transdermal, nasal spray and inhaler) and numerous other clinical trials, there has been no major improvement in effectiveness for smoking cessation, just an increase in the choice of how the nicotine replacement therapy (NRT) is administered. Smoking cessation rates with NRT are similar in subjects with serious chest and cardiovascular disorders. There is no evidence that intensive counselling improves the smoking cessation rates with NRT over standard counselling. The first major alternative to NRT introduced for smoking cessation was bupropion, an inhibitor of the neuronal uptake of noradrenaline and dopamine. Bupropion is effective for smoking cessation, and effectiveness is improved by a moderate level of counselling. A long-term direct comparison of bupropion with transdermal nicotine showed than bupropion was more effective than nicotine. Despite this, NRT remains the standard treatment for smoking cessation in many countries. An exciting new development for the treatment of smoking cessation is varenicline, a partial agonist at nicotinic α₄β₂ receptors. A direct comparison of varenicline with bupropion has shown that varenicline is as least as good as and probably more effective than bupropion for smoking cessation. At present, the number of subjects who have used varenicline in clinical trial is relatively small, and probably does not allow assessment of any rare serious adverse effects. Thus, it may be premature to recommend varenicline for smoking cessation in preference to bupropion.     

Cessation Strategies Young Adult Smokers Use After Participating in a Facebook Intervention

Background: Young adults underutilize current evidence-based smoking cessation strategies; yet social media are widely used and accepted among this population. A better understanding of whether and how young adults try to quit smoking in the context of a social media smoking cessation intervention could inform future intervention improvements. Objectives: We examined frequency, strategies used, and predictors of self-initiated 24-hour quit attempts among young adults participating in a Facebook intervention. Methods: A total of 79 young adult smokers (mean age = 20.8; 20.3% female) were recruited on Facebook for a feasibility trial. Participants joined motivationally tailored private Facebook groups and received daily posts over 12 weeks. Assessments were completed at baseline, 3-, 6-, and 12-month follow-up. Results: In 12 months, 52 participants (65.5%) completed 215 quit attempts (mean = 4.1; median = 4; range 1-14); 75.4% of attempts were undertaken with the Facebook intervention alone, 17.7% used an electronic cigarette (e-cigarette), 7.4% used nicotine replacement therapy (NRT), and 3.7% used additional professional advice. Non-daily smokers, those who smoked fewer cigarettes, and those in an advanced stage of change at baseline were more likely to make a quit attempt. E-cigarette use to aide a quit attempt during the study period was associated with reporting a past year quit attempt at baseline. No baseline characteristics predicted NRT use. Conclusions: After participating in a Facebook smoking cessation intervention, young adults predominantly tried to quit without additional assistance. E-cigarettes are used more frequently as cessation aid than NRT. The use of evidence-based smoking cessation strategies should be improved in this population.     

Pharmacotherapies and harm-reduction options for the treatment of tobacco dependence

Introduction: Tobacco dependence, a chronic relapsing condition, requires repeated interventions and multiple attempts to quit.

Areas covered: Strategies for assisting smoking cessation include behavioural counselling and pharmacotherapy. Three drugs are currently used as first-line pharmacotherapy: nicotine replacement therapy (NRT), bupropion and varenicline. Compared to placebo, the drug effect varies from RR = 2.27 for varenicline, to 1.69 for bupropion, and 1.60 for any form of NRT. Cytisine (similar to varenicline) has a RR = 3.98 compared to placebo (two trials). Second-line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments.

Expert opinion: Effective medications exist, and clinicians should encourage and offer treatment to every smoker. However, most smokers try to quit by themselves, with only about 3% quitting successfully each year. Alternative interventions are needed. Harm reduction has not received much support to date. Safer alternative to tobacco smoking (smoke-free products, long-term use of cessation drugs, or electronic cigarettes) could save lives and reduce the burden of tobacco-related deaths and diseases. Despite some encouragement to develop a research agenda for e-cigarettes, particularly on the safety issues, too little attention has been brought to this area of research.     

Adding addiction to the transtheoretical model for smoking cessation

Addiction is important to account for when designing smoking cessation interventions as withdrawal symptoms impede quitting. Ameliorating symptoms may increase those successfully quitting. A two-group, two-time, five-week, multi-site experimental design using the Transtheoretical Model examined whether addiction predicted post-intervention smoking behavior (point prevalence and stage of change), controlling for NRT (nicotine replacement therapy use) in adult FreshStart participants (N=109). The intervention group self-designated an Indigenous Helper (IH) Inde from their social network; the control group did not. The Fagerstrom Test for Nicotine Dependence (FTND) and the Stage of Change questionnaire were completed at baseline and 4 weeks. NRT use, but not the FTND, predicted smoking behavior. There is a need for an accurate nicotine addiction measure. Future smoking cessation studies should include NRT as a covariate.     

Smoking cessation interventions for in-patients: a selective review with recommendations for hospital-based health professionals

A selective review of the literature was conducted to provide evidence-based recommendations for the clinical management of hospitalized smokers. The Cochrane library, in particular the Cochrane review of 'Interventions for smoking cessation in hospitalised patients', was the basis for the review and was supplemented with other clinical and non-clinical literature where the review did not inform clinicians sufficiently. Evidence was reviewed on issues considered by the authors to be of importance to health professionals interested in providing a smoking cessation intervention to their patients. The review suggests that effective hospital interventions: incorporate an in-patient intervention lasting greater than 20 minutes in duration with extended post discharge follow-up; consist of at least five intervention contacts; and be delivered over at least a 3-month period. Furthermore, interventions should include in-patient advice and counselling, the provision of nicotine replacement therapy and extended proactive post discharge telephone support. The review also indicates that cessation interventions are particularly effective when delivered to patients with a cardiovascular diagnosis. All health professionals may be effective in providing cessation treatments; however, the addition of a specialist smoking cessation counsellor appears to improve interventions in this setting. Finally, without the development of supportive systems, routine intervention with smoking patients by health professionals is unlikely. Recommendations for the delivery of effective smoking cessation interventions in hospitals are provided. [Wolfenden L, Campbell E, Walsh RA, Wiggers J. Smoking cessation interventions for in-patients: a selective review with recommendations for hospital-based health professionals. Drug Alcohol Rev 2003;22:437 - 452]     

Nicotine-replacement therapy in pregnancy-the end of the road?

ABSTRACT:: Smoking in pregnancy is associated with serious perinatal risks, leading to attempts to prevent smoking with the use of nicotine-replacement therapy (NRT). After more than a decade of studies failing to show the effectiveness of NRT for smoking cessation in pregnancy, a recent large, randomized trial has clearly shown that the failure may be caused by >90% dropout rate. Several secondary analyses of randomized trials have shown that NRT is efficacious in decreasing smoking in pregnancy and in optimizing fetal growth among women who take the product. But to be effective in smoking cessation, any drug has to be taken by the patients. Can we overcome the dismal rates of pregnant women's adherence to NRT, so we can save unborn babies from the serious risks associated with their mothers' smoking?     

Which is the best primary medication for long-term smoking cessation--nicotine replacement therapy, bupropion or varenicline?

Nicotine chewing gum has been available since 1982, when it was shown to increase smoking cessation rates by approximately 1.5- to 2-fold after 12 months. Despite the introduction of many other preparations of nicotine (sublingual, lozenge, transdermal, nasal spray and inhaler) and numerous other clinical trials, there has been no major improvement in effectiveness for smoking cessation, just an increase in the choice of how the nicotine replacement therapy (NRT) is administered. Smoking cessation rates with NRT are similar in subjects with serious chest and cardiovascular disorders. There is no evidence that intensive counselling improves the smoking cessation rates with NRT over standard counselling. The first major alternative to NRT introduced for smoking cessation was bupropion, an inhibitor of the neuronal uptake of noradrenaline and dopamine. Bupropion is effective for smoking cessation, and effectiveness is improved by a moderate level of counselling. A long-term direct comparison of bupropion with transdermal nicotine showed than bupropion was more effective than nicotine. Despite this, NRT remains the standard treatment for smoking cessation in many countries. An exciting new development for the treatment of smoking cessation is varenicline, a partial agonist at nicotinic alpha4beta2 receptors. A direct comparison of varenicline with bupropion has shown that varenicline is as least as good as and probably more effective than bupropion for smoking cessation. At present, the number of subjects who have used varenicline in clinical trial is relatively small, and probably does not allow assessment of any rare serious adverse effects. Thus, it may be premature to recommend varenicline for smoking cessation in preference to bupropion.     

Clinical efficacy of bupropion in the management of smoking cessation

Nicotine addiction is a chronic relapsing condition that can be difficult to treat. Until recently, pharmacological options for the treatment of tobacco dependence were primarily limited to nicotine replacement therapy (NRT). Sustained-release bupropion (bupropion SR) is the first non-nicotine pharmacological treatment approved for smoking cessation. Bupropion SR is recommended for first-line pharmacotherapy alongside NRT in the updated US Clinical Practice Guidelines and the UK Health Education Authority Guidelines. The UK National Institute of Clinical Excellence recommends NRT and bupropion SR for smokers who have expressed a desire to quit smoking. This review presents evidence that bupropion SR is an effective first-line therapy for smoking cessation in a wide range of patient populations. It is associated with significantly higher smoking cessation rates compared with placebo in patients with or without a history of prior bupropion SR or NRT use, and its effect is independent of gender. Bupropion SR treatment is effective in the prevention of relapse to smoking in those patients who have successfully quit, and re-treatment is effective in smokers who recommence smoking after a previous course of bupropion SR. Bupropion SR treatment relieves the symptoms of craving and nicotine withdrawal, and attenuates the weight gain that often occurs after smoking cessation. Data collected from motivational support programmes and employer-based studies provide strong evidence of the effectiveness of bupropion SR as an aid to smoking cessation in 'real life' situations, and confirm the efficacy seen in clinical trials.     

The effects of exercise and nicotine replacement therapy on smoking rates in women

PURPOSE: To examine the individual effects of supervised and intensive exercise as well as the combined effects of exercise and nicotine replacement therapy (NRT) on (a) smoking cessation and reduction rates and (b) psychological and physiological processes during withdrawal. METHODS: One-hundred and forty-two inactive female smokers were randomised into the following four groups: exercise+nicotine patch; exercise+no nicotine patch; cognitive behavior therapy (CBT)+nicotine patch and CBT+no nicotine patch. Smoking abstinence (verified by saliva cotinine and expired carbon monoxide), cessation self-efficacy, and physical fitness and body weight were assessed at baseline (week 1), quit date (week 6), program termination (week 12), and 3- and 12-month follow-up. RESULTS: There were significant differences in a 7-day point prevalence but not continuous abstinence rates between treatment groups across targeted end points. Consistently higher cessation rates were seen when NRT was added to both treatment programs. Compared with CBT participants, exercise participants had significantly increased functional exercise capacity and had gained significantly less weight during program end points but these differences did not hold at a 12-month follow-up. Compared with exercise participants, CBT participants felt greater cessation efficacy and reported greater knowledge, coping and support resources across all end points. CONCLUSIONS: Exercise combined with NRT facilitates smoking cessation, improves functional exercise capacity, and delays weight gain in women smokers. We recommend that physicians and health care professionals recommend exercise and NRT together for highly motivated women interested in quitting smoking.