Precessation treatment with nicotine skin patch facilitates smoking cessation

Nicotine Research Program, VA Medical Center and Department of Psychiatry, Duke University Medical Center, Durham, NC 27705, USA.
Nicotine & Tobacco Research (Impact Factor: 3.3). 03/2006; 8(1):89-101. DOI: 10.1080/14622200500431866
Source: PubMed


Nicotine replacement therapy (NRT) is a well-established treatment to aid smoking cessation, and current products recommend using NRT only after quitting smoking. However, theoretical arguments and previous data support the hypothesis that precessation use of NRT might be useful in reducing dependence on inhaled nicotine and serve as a helpful prelude to smoking cessation. The present study explored the use of NRT for 2 weeks before a target quit-smoking date, during which subjects continued to smoke ad libitum. Three experimental conditions varied the nicotine delivery of the cigarettes smoked during these 2 weeks so that we could examine the effects of concurrent nicotine administration on compensatory smoking of low tar and nicotine cigarettes. Subjects smoked (a) their usual brands of cigarettes, (b) conventional low tar and nicotine cigarettes, or (c) denicotinized cigarettes. After the quit date, subjects received pharmacotherapy consisting of various doses of NRT (0, 21, or 42 mg/24-hr) in combination with the nicotinic antagonist mecamylamine (10 mg/day). Results showed that precessation nicotine patch treatment was associated with a significantly higher rate of continuous smoking abstinence at 4 weeks, regardless of cigarette condition. Ad libitum smoking before the target quit date was modulated by nicotine patch treatment, and compensatory increases in smoking low tar and nicotine cigarettes were prevented by concurrent use of nicotine patches. These results suggest that use of NRT before a target quit-smoking date deserves further evaluation as a possible smoking cessation treatment. Moreover, while nicotine patches were well tolerated when subjects smoked nicotine-containing cigarettes, the use of nicotine skin patches with reduced-nicotine cigarettes potentially offers the advantage of increased efficacy without introducing concern about toxic effects of excessive nicotine intake.

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    • "The typical dose schedule for varenicline involves a 1- week pretreatment phase to ensure that smokers achieve a steady state medication level when smoking abstinence is initiated (Gonzales et al. 2006; Jorenby et al. 2006; Nides et al. 2006). This pretreatment period may also promote smoking cessation success by reducing smoking reinforcement and dependence on inhaled nicotine during the pretreatment period (Rose et al. 2006). The possibility that varenicline may also improve quit rates through an extinction mechanism derives from the observation that 1- week point prevalence smoking abstinence rates increase over the first 4 weeks following the quit date as compared to placebo (Gonzales et al. 2006). "
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    ABSTRACT: RationaleVarenicline, an approved smoking cessation pharmacotherapy, also shows promise as a potential treatment for alcohol dependence. However, varenicline has not been tested in heavy drinkers, and it remains to be determined whether varenicline could reduce alcohol craving and consumption in smokers who are trying to quit smoking. ObjectivesWe conducted a preliminary study to examine the effect of varenicline on drinking behavior and the effects of extended varenicline pretreatment on smoking. MethodsThirty heavy drinking smokers received smoking cessation counseling and were randomly assigned to receive either an extended 4-week pretreatment with varenicline 2mg daily or the usual 1-week pretreatment. Those in the extended pretreatment group received active medication for 8weeks (i.e., 4weeks of active pre-treatment followed by 4weeks of active treatment), and participants in the usual pretreatment group received active medication after a placebo lead in (i.e., 3weeks of placebo followed by active medication for 5weeks). ResultsParticipants who received varenicline during the first 3weeks reported significantly greater reductions in alcohol craving and numerically fewer heavy drinking days compared to those who received placebo, and these differences persisted during the open-label phase. Extended pretreatment was associated with numerically greater reductions in cigarette smoking over the entire study period. There were no differences, however, in smoking abstinence rates following the smoking quit date between the two groups. ConclusionsFindings from this preliminary study suggest that varenicline may be a promising strategy for concurrently reducing heavy drinking and promoting smoking changes in heavy drinkers. KeywordsSmoking cessation–Varenicline–Heavy drinking–Alcohol craving
    Psychopharmacology 06/2011; 215(4):655-663. DOI:10.1007/s00213-010-2160-9 · 3.88 Impact Factor
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    • "Only two studies reported change in dependence over the pre-quit period (Hughes et al. 2010; Rose et al. 2006). Hughes et al. (2010) reported that participants in the preloading condition decreased their dependence by increasing the time to first cigarette after waking from 15 to 28 min, whereas this measure of dependence did not change in the control group. "
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    ABSTRACT: Using nicotine replacement therapy (NRT) whilst smoking, prior to quitting, is called preloading. Two reviews have estimated the effect of preloading on abstinence, but need updating. Neither investigated possible mediators or moderators of the effect, which could have implications for individual treatment plans. To update the nicotine preloading efficacy estimate and test four hypotheses: (1) Efficacy is mediated through reduced smoking reward, (2) efficacy is mediated through increased NRT adherence post-quit, (3) efficacy is mediated through increased confidence, and (4) behavioural support modifies efficacy. Randomised controlled trials were included that allocated cigarette smokers attempting to quit to either a preloading or control condition. A Mantel–Haenszel fixed-effect model was used to calculate risk ratios from quit rates at short- and long-term follow-ups. We carried out sub-group analyses and synthesised the data available on possible mediators and moderators qualitatively. Eight relevant studies were included, with 2,813 participants. The risk ratio (RR) for short-term abstinence was 1.05, 95% confidence intervals (CI) = 0.92, 1.19, and for long-term abstinence 1.16, 95% CI = 0.97, 1.38. There was a marginal benefit of using nicotine patch rather than gum for preloading, significant at short-term follow-up, and no significant benefit of more intensive pre-quit behavioural support. We found a weak non-significant effect of nicotine preloading on abstinence. None of our mediational hypotheses received strong support, however evidence suggests that efficacy was enhanced by the patch over acute NRT. Future research needs to investigate the mechanisms of preloading by carrying out mediational analysis.
    Psychopharmacology 11/2010; 214(3):579-92. DOI:10.1007/s00213-010-2069-3 · 3.88 Impact Factor
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    • "The main findings of our study were that ( 1 ) craving for cigarettes and nicotine dependence were reduced by a regimen of smoking denicotinized cigarettes in conjunction with wearing nicotine skin patches and ( 2 ) a reduction in metabolic activity of the anterior cingulate cortex ( right hemisphere ) accompanied the denicotinized cigarette + nicotine patch treatment , and this change in activity was greatest for those subjects who adhered to the denicotinized cigarette treatment regimen . The reduction in dependence accompanying switching to denicotinized cigarettes in combination with nicotine patch treatment was consistent with previous findings reported using similar procedures ( Rose et al , 2006 ) . We hypothe - sized that the dissociation between the act of smoking and receipt of nicotine would promote extinction of the reinforcing properties of cigarettes , thereby reducing craving during periods of abstinence . "
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    ABSTRACT: Fifteen smokers participated in a study investigating brain correlates of nicotine dependence. Dependence was reduced by having subjects switch to denicotinized cigarettes for 2 weeks while wearing nicotine skin patches. Positron emission tomography (PET) scans assessed regional cerebral metabolic rate for glucose (rCMRglc) after overnight nicotine abstinence on three occasions: (1) at baseline; (2) after 2 weeks of exposure to denicotinized cigarettes+nicotine patches; and (3) 2 weeks after returning to smoking the usual brands of cigarettes. Craving for cigarettes and scores on the Fagerström Test of Nicotine Dependence (FTND) questionnaire decreased at the second session relative to the first and last sessions. Regional brain metabolic activity (normalized to whole brain values) at session 2 also showed a significant decrease in the right hemisphere anterior cingulate cortex. Exploratory post hoc analyses showed that the change in craving across sessions was negatively correlated with the change in rCMRglc in several structures within the brain reward system, including the ventral striatum, orbitofrontal cortex and pons. The between-session difference in thalamus activity (right hemisphere) was positively correlated with the difference in FTND scores. Correlational analyses also revealed that reported smoking for calming effects was associated with a decrease (at session 2) in thalamus activity (bilaterally) and with an increase in amygdala activity (left hemisphere). Reported smoking to enhance pleasurable relaxation was associated with an increase in metabolic activity of the dorsal striatum (caudate, putamen) at session 2. These findings suggest that reversible changes in regional brain metabolic activity occur in conjunction with alterations in nicotine dependence. The results also highlight the likely role of thalamic gating processes as well as striatal reward and corticolimbic regulatory pathways in the maintenance of cigarette addiction.
    Neuropsychopharmacology 01/2008; 32(12):2441-52. DOI:10.1038/sj.npp.1301379 · 7.05 Impact Factor
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