Article

Precessation treatment with nicotine skin patch facilitates smoking cessation

Duke University, Durham, North Carolina, United States
Nicotine & Tobacco Research (Impact Factor: 3.3). 03/2006; 8(1):89-101. DOI: 10.1080/14622200500431866
Source: PubMed

ABSTRACT

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: Rationale Varenicline, 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. Objectives We conducted a preliminary study to examine the effect of varenicline on drinking behavior and the effects of extended varenicline pretreatment on smoking. Methods Thirty heavy drinking smokers received smoking cessation counseling and were randomly assigned to receive either an extended 4-week pretreatment with varenicline 2 mg daily or the usual 1-week pretreatment. Those in the extended pretreatment group received active medication for 8 weeks (i.e., 4 weeks of active pre-treatment followed by 4 weeks of active treatment), and participants in the usual pretreatment group received active medication after a placebo lead in (i.e., 3 weeks of placebo followed by active medication for 5 weeks). Results Participants who received varenicline during the first 3 weeks 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. Conclusions Findings from this preliminary study suggest that varenicline may be a promising strategy for concurrently reducing heavy drinking and promoting smoking changes in heavy drinkers.
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    • "Using the abused drug while the replacement therapies are present may help to extinguish the drug-seeking response. Recent evidence in smokers suggests that smoking while wearing nicotine patches for 2 weeks before attempting to quit smoking increases later abstinence rates (Rose, Behm, Westman, & Kukovich, 2006 ;Shiffman & Ferguson, 2008). This effect appears to be even stronger if an individual smokes nicotine-free cigarettes while wearing the nicotine patch, perhaps because smoking these placebo cigarettes reduces the strength of R-O associations. "
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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.
    Full-text · Article · Nov 2010 · Psychopharmacology
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