Tobacco smoking is a major modifiable risk factor for death worldwide. Smoking tops the list of leading causes of noncommunicable diseases along with arterial hypertension, hypercholesterolemia, alcohol abuse, lack of physical activity and unhealthy diet. The contribution of smoking to the overall mortality rate is 17%, and to the total loss due to disability – 13%. Unfortunately, many people, even among doctors, perceive smoking as just a bad habit, and not as a modifiable risk factor that increases the overall risk of death to the greatest degree, and nicotine addiction is not like a disease requiring treatment.
Most Smokers Want to Quit Smoking and Have Tried Repeatedly
Nicotine addiction is a chronic condition similar to other types of addiction to any substance, requiring repeated interventions to achieve and maintain persistent smoking cessation. Nicotine contained in tobacco causes the development of a persistent adherence to smoking. After several weeks of daily smoking, cessation is usually accompanied by withdrawal. Nicotine acts as a complete agonist of nicotinic acetylcholine receptors (n-AChR) in the central nervous system, activates dopaminergic pathways in the mesolimbic system of the brain and thus promotes the development of attraction and dependence. In chronic smokers who quit smoking, dopamine secretion is reduced. It has been experimentally shown that some subtypes of n-AChR transmit the primary effects of nicotine in the brain. Dopamine, the release of which is stimulated by nicotine, also activates glutamatergic and aminobutyric neurons containing n-AChR, which can have a stimulating effect on smokers. Dopamine is a neurotransmitter of pleasure and its release during tobacco smoking determines the sense of satisfaction from smoking. The smoker’s body needs nicotine or without it, symptoms of withdrawal appear, which makes you smoke again.
Seven First-Line Drugs
Anti-nicotine drugs significantly increase the likelihood of prolonged smoking cessation:
- nicotine chewing gum
- nicotine inhaler
- nicotine lollipops,
- nicotine nasal spray,
- nicotine-containing patch
- bupropion MD
A doctor should also consider the possibility of using combinations of drugs in cases where monotherapy is not effective enough and at the same time, the efficacy of the combination proposed for prescribing is greater than monotherapy. Reputable pharmacists from the global online drug store delivering drugs to your door Canadian family pharmacy claim that consultations and drug therapy are individually effective for the treatment of nicotine addiction, but in combination their effectiveness is increased. Therefore, clinicians should try to ensure that each patient receives both consultative and medical care. Such type of care is available as a set of patient assistance available in the website of the service, where the weight is given to the economical availability of pharmaceutical solutions and informational support. Smoking cessation products can be ordered confidentially with short-time delivery, with detailed explanations and professional advice on their application to follow for the optimal therapy outcomes.
If a smoker is currently not inclined to make an attempt to stop smoking, it is necessary to motivate him to such attempts in the future. The treatment of nicotine addiction is effective both clinically and economically. The provision of counseling and medications for the treatment of nicotine addiction free of charge for the patient increases the likelihood of a successful outcome. Insurers and health workers should include methods that have proven efficacy in their insurance plans, as they are economically viable.
What Drugs Are Recommended?
- Herbal preparation made in Bulgaria containing an alkaloid isolated from the plant Cytisus laburnum (broom) has the mechanism of action similar to nicotine. When smoking while taking cytisine, the effect of nicotine is combined with the effect of cytisine, which leads to the appearance of unpleasant symptoms of nicotine overdose. This makes a patient gradually stop smoking without experiencing withdrawal symptoms, since the effect of nicotine is replaced by the action of cytisine.
- The meta-analysis data comparing the efficacy of 2 nicotine-free preparations – bupropion and varenicline, indicate a significant and significantly greater effectiveness of the latter. Those taking varenicline were more than 2 times more likely to stop smoking than those taking bupropion.
- According to meta-analyzes, all the recommended methods of drug treatment for nicotine addiction are significantly superior to placebo.
- Drugs that are not recommended for the treatment of nicotine addiction due to the lack of evidence of their effectiveness for these purposes are serotonin reuptake inhibitors (sertaline, fluoxetine), anxiolytics (buspirone, diazepam), blockers (anaprilin), opioid receptor antagonists (naltrexone), silver acetate, mecamylamine.
The Action of Varenicline
Varenicline is an n-AChR agonist with high affinity and selectivity for the 4 4–2 subtypes of n-AChR. The degree of activation of n-AChR by varenicline is lower than by nicotine — it is released 40-60% less dopamine than in response to nicotine. This provides a smoker with a sense of comfort without withdrawal symptoms in the absence of nicotine, without leading to the development of drug dependence. Having a greater affinity for receptors compared to nicotine, varenicline blocks for it the ability to connect with receptors, thus exhibiting antagonist properties. When smoking while taking varenicline, dopamine level does not increase further, which does not lead to pleasure, and the need for smoking is reduced.
Varenicline is administered orally in tablets of 0.5–2.0 mg per day. The duration of treatment is usually 12 weeks. Taking the drug begins 1 week before the expected date of quitting smoking – the patient takes the drug and continues to smoke, and after a week tries to stop smoking. If it fails, a retry occurs after 1 week, etc. Most patients manage to stop smoking in the first 2 weeks of treatment. If this is not possible by the 12th week, an additional 12 weeks of treatment increase the likelihood of a successful result, including the long-term effectiveness of quitting.