Drugs with proven effectiveness in smoking cessation are:
- nicotine replacement therapy (NTZ),
- antidepressant – bupropion hydrochloride,
- partial nicotinic receptor agonists – varenicline (synthetic medicine) and cytisine (herbal medicine).
The goal of NTZ is to provide nicotine to the body of an addict to reduce the symptoms of abstinence and help them focus on changing behavior and learning to live without tobacco. “Nicotine replacement therapy should be used for 8-12 weeks, starting with high and maximum doses, gradually reducing them. It is best to use double nicotine therapy: a patch, i.e. a long-acting form, and leave the patient with a short-acting form, i.e. chewing gum or spray. ”
Bupropion hydrochloride therapy is the least popular in Poland. Bupropion hydrochloride is an inhibitor of dopamine and norepinephrine reuptake. Acting probably in a reward system reduces the desire to smoke. Bupropion doubles the incidence of permanent smoking cessation compared to placebo.
At the beginning of therapy, the patient smokes and simultaneously takes the medicine. Smoking cessation occurs in the second week of therapy. Duration of treatment is about 7 weeks. Odens snus
Varenicline treatment is becoming more and more popular in smoking cessation. It is a partial agonist of the A4B2 nicotinic acetylcholine receptor. It stimulates the secretion of dopamine, which results in a reduction of craving for nicotine. At the beginning, the patient simultaneously takes the medicine and smokes. In the second week, smoking will be discontinued. Duration of treatment is 12-24 weeks.
A recently published meta-analysis has shown that the use of varenicline more than triples the chance of permanently quitting smoking compared to placebo. The same meta-analysis showed 66 percent greater its effectiveness compared to bupropion.
“For many years, bupropion hydrochloride and varenicline have been treated as drugs that may increase the risk of suicide, and worsen the patient’s mental state. However, it should be remembered that among people with mental disorders the number of smokers is definitely higher than in mentally healthy people. This group of patients will be more likely to use medication to free themselves from addiction and may have side effects more often. In 2009, the FDA introduced a warning against the use of these drugs, but in 2016, after publishing the results of many studies, it was withdrawn. So these are safe medicines and can be used in people with mental disorders who use drug therapy related to mental illness. Except for monoamine oxidase (MAO) inhibitors. ”
Cytisine, a herbal medicine that reduces the need for nicotine, is very popular in UK, although there is no such extensive literature confirming its effectiveness as other substances. Nevertheless, observations from its use confirm the usefulness of this drug. Used after stopping smoking, it alleviates the symptoms of withdrawal syndrome.
The most effective: combined NTZ and varenicline
“Regarding the effectiveness of pharmacotherapy, it is known from randomized trials that nicotine replacement therapy in a single form is better than not using any therapy. Combined NTZ, i.e. long and short acting form, is more effective than single form. Bupropion was not better in studies than nicotine replacement therapy, while varenicline was better than single nicotine replacement therapy, “says Dr. Buczkowski.
“One meta-analysis shows that drugs used to treat nicotine addiction are effective and very effective. The most effective is nicotine replacement therapy using two forms, i.e. long and short acting, and varenicline with little indication of varenicline. ”
Smokers are increasingly turning to electronic cigarettes. “However, this is not a method of treatment, i.e. it is not a procedure that ultimately is to lead to quitting the habit” – sums up Dr. Buczkowski.
The effectiveness of behavioral activities proven in research is up to 8 percent. If we add pharmacotherapy to this, the effectiveness will increase to a dozen or so percent. After a year.
Opinion of a cardiologist: Over 50% smokers continue smoking after a heart attack
Menthol cigarettes are harmful to the same extent as traditional cigarettes, and differences between individual brands do not justify creating one as less harmful. Every cigarette is harmful, everyone increases the risk of heart attack and cancer.
Recently announced results of the POLASPIRE survey indicate that over 50 percent. smokers continue smoking after a heart attack or coronary angioplasty. Despite the significant development of medicine in the last quarter of a century, including the development of new treatments for tobacco addiction syndrome, the situation regarding smoking by people with heart and vascular disease remains unresolved. The challenge for specialists is therefore to develop a new, effective strategy for secondary prevention.
The use of electronic cigarettes is less harmful because of the development of cancer and the risk of heart and vascular disease. Unfortunately, there is a concern that electronic cigarettes will remove the negative odium from smoking and, as a consequence, will be more often used by children and young adults. This danger should be remembered.