New Medications: what's coming?
The most promising new medications for the immediate future
are varenicline and rimonabant. Varenicline partially
substitutes for nicotine and appears to produce very high
quit rates. Rimonabant blocks cannabanoid receptors and
not only increases quit rates but appears to completely
reverse post-cessation weight gain. Although mecamylamine
(a nicotine blocker), naltrexone (an opioid blocker) and
replacing the sensory aspects of smoking appear promising,
no recent studies have been published. Vaccines to block
nicotine entry into the brain have not yet reached clinical
trials. Getting used to NRT prior to quitting or using
NRT to reduce prior to quitting appears promising. Also,
giving NRT to smokers not interested in quitting to reduce
appears to prompt new quit attempts and abstinence. Increasing
the dose or duration of treatment does not appear helpful.
SSRI antidepressants do not help smokers stop.
John R Hughes, MD is Professor of Psychiatry, Psychology
and Family Practice at the University of Vermont. Dr Hughes
is board certified in Psychiatry and Addiction Psychiatry.
His major focus has been clinical research on tobacco
use. Dr Hughes was the recipient of the first Ove Ferno
Award for research on nicotine dependence and the Alton
Ochsner Award Relating Smoking and Health. He is a co-founder
and past president of the Society for Research on Nicotine
and Tobacco. Dr Hughes is Chair of the Vermont Tobacco
Evaluation and Review Board which oversees VT's multi-million
dollar tobacco control programmes.
Professor, Department of Psychiatry, University of Vermont