Nicotine replacement therapy can he...

Nicotine replacement therapy can help moti-vated patients stop smoking, if it be not that long-term abstinence is a more difficult goal. Patient choice which often guides the choice of a particular emblem of treatment, does not improve the consequence of nicotine replacement therapy. Lerman and associates compared the efficacy of transdermal nicotine with nicotine nasal spray to identify patient characteristics that might predict treatment outcomes

These brace forms of nicotine replacement therapy were chosen because of their differing pharmacodynamics, with transdermal preparations offering a gradual nicotine administration with a four- to six-hour steady state, while the nasal spray more closely mimics the immediate nicotine peak achieved with smoking cigarettes. Healthy, treatment-seeking smoker were chronicleed in a randomized, open-label, eight-week clinical trial of trans-dermal nicotine (Nicoderm CQ 21 mg tapering after four weeks) versus nicotine nasal spray (Nicotrol, 10-mg dose given as 05-mg spray in each nostril with a maximum of five doses through hour, tapered after four weeks) for smoking cessation. All patients received seven sessions of standarized behavioral cluster therapy. Smoking status was assessed according to telephone, first at the finis of treatment (eight weeks after the target quit date), and again six month after the target quit date.

The transdermal nicotine cluster achieved a higher prolonged abstinence rate [i]or[/i] part of to the other the end of treatment (625 percent) com-pared with the nicotine nasal spray arrange (44.5 percent). Six months later, abstinence rates were not significantly different in the sum of two units groups (28.5 versus 24.5 percent) No serious adverse occurrences were reported. White, nonobese smoker with grave to moderate levels of nicotine concatenation had a better response to transdermal nicotine.

The authors deduce that pretreatment patient characteristics may help in the individualization of nicotine replacement therapy. Transdermal nicotine is a more effective treatment in white, nonobese smoker who have subdued nicotine dependence, while nicotine nasal spray is more beneficial in obese smoker who are highly nicotine contingent and members of minority groups

Lerman C et al. Individualizing nicotine replacement therapy for the treatment of tobacco stay Ann Intern Med March 16 2004;140:426-33

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