In smoking cessation, the administration of nicotine replacement therapy and smoking cessation medications, both when used alone and in combination with other smoking cessation procedures, such as behavioral therapy, represents an important factor in influencing the likelihood of success in quitting addictive behaviors. However, it is crucial to separate nicotine replacement therapy from medication-assisted smoking cessation. Unlike nicotine replacement therapy, medication-assisted treatment does not involve substitution of nicotine in a modified form; instead, it uses a variety of mechanisms to reduce addictive behavior.
Indications (areas of application)
- Prevention of secondary diseases
- Secondary prevention of already existing diseases – e.g. chronic obstructive pulmonary disease (COPD) or hypertension (high blood pressure).
- (Part of the) rehabilitation after diseases associated with smoking.
- Protection of non-smokers
- Protection of the unborn child during pregnancy
Contraindications
- Pregnancy
- Breastfeeding
- Arrhythmias (relative contraindication)
- Renal dysfunction (relative contraindication).
The procedures
Smoking cessation by nicotine replacement therapy.
Quitting addictive behaviors using nicotine replacement therapy can be accomplished, for example, with nicotine patches (different strengths and patch systems) and nicotine gum (2 and 4 mg; different flavors), which serve as nicotine carriers. Other dosage forms include: Nicotine sublingual tablets (2 mg), nicotine lozenges (1.5 and 4 mg), nicotine inhalers (10 mg), and nicotine nasal spray (no longer commercially available in Germany). Regardless of the carrier, a defined amount of nicotine is delivered to the body over a period of time to reduce addiction symptoms without the need to engage in actual addictive behavior in the form of smoking to obtain nicotine. Nicotine replacement therapy should not be given for longer than 12 weeks and should be gradually reduced during this period. Basic principles of nicotine replacement therapy for smoking cessation.
- The basic principle of nicotine replacement therapy is based on substituting nicotine without exercising the addictive behavior. Hereby, the withdrawal symptoms can be alleviated or completely inhibited without the affected person having the desire to smoke.
- The withdrawal symptomatology is primarily based on the function of nicotine on the human organism. Of crucial importance for the effect of nicotine is to consider the development of tolerance. Thus, nicotine intake over a longer period of time leads to craving for a higher amount of the substance in order to suppress the withdrawal symptoms. If one considers the biochemical effects of nicotine uptake and degradation in the organism, it becomes clear that nicotine leads to significant vasoconstriction (vasoconstriction) even after a short period of time. Far more important for the smoker, however, is the significant increase in emotional state. However, if the addictive behavior is not maintained, the well-being is reduced significantly below baseline compared to a non-smoker.
- Furthermore, nicotine intake reduces fatigue and at the same time attenuates a possible sense of anxiety. However, the decrease in the feeling of hunger is particularly problematic, which also encourages young women in particular to take up and maintain the addictive behavior. If smoking is stopped, a replacement behavior for smoking is usually necessary, so that more food is often consumed by the affected person. The resulting weight gain often leads to a resumption of the addictive behavior. In this case, nicotine replacement therapy is particularly helpful, as it slowly reduces the addiction and thus prevents rapid weight gain.
- In addition, smoking causes an increased release of hormones. In particular, the messenger substance serotonin, which is important in the brain and is necessary for the increase of well-being and thus also the target of further substances of abuse, can be released by nicotine increased.
- As nicotine replacement products, chewing gum, patches, nasal sprays and nicotine sublingual tablets (tablets are placed under the tongue) are used.Depending on the addictive behavior, it may be necessary to combine the various products, if necessary, in order to be able to alleviate the withdrawal symptoms. However, this should only be done in consultation with a physician. Because of this, therapy with nicotine replacement products also represents an individual measure. The treatment should be carried out over a period of two to three months. It is important to note that the individual preparations differ in nicotine content. Patches with 24.9 milligrams, for example, release 0.9 to 0.6 milligrams of nicotine per hour through the skin. In contrast, chewing gum with a strength of four milligrams can be used in a number up to 16 pieces per day. For a better estimate of the dependence and the amount of nicotine necessary from this, the Fagerström test can be performed.
- A Cochrane meta-analysis suggests that nicotine-containing e-cigarettes can help slightly more people quit smoking tobacco cigarettes for at least six months than other nicotine replacement products or even nicotine-free e-cigarettes
- Smoking cessation with nicotine replacement products is a near-optimal method under medical guidance, with a success rate of 40 percent under outpatient conditions.
Smoking cessation through drug treatment.
For pharmacotherapy for smoking cessation, diverse substances with different mechanisms of action can be named. All have in common the goal of significantly reducing the symptoms of addiction, thereby reducing the need to reach for a cigarette or achieve permanent abstinence. Basic principles of drug treatment for smoking cessation
- Bupropion (bupropion hydrochloride; bupropion HCL) – this substance is a drug primarily used against depression. Even at a dosage below the effective amount used for depression, a reduced desire to engage in addictive behavior can be observed in some patients. Generally, bupropion is taken for 9 weeks. In contrast to nicotine replacement therapy, however, isolated side effects can be observed, such as sleep disturbances (insomnia), tremors, headaches (cephalgia), concentration problems,dizziness, dry mouth, gastrointestinal (stomach and intestinal) disturbances, as well as nausea (nausea) and vomiting. Furthermore, bupropion may increase the risk of pancytopenia (synonym: tricytopenia; reduction of all three cell series in the blood: leukocytopenia (reduced number of white blood cells), anemia (anemia), and thrombocytopenia/reduced number of platelets). Occasionally, seizures occur while taking bupropion, so there is a contraindication for an existing increased risk of epileptic events.
- Varenicline – this drug is substance that specifically affects the nicotinic cholinergic receptor (cholinergic – dependent on acetylcholine) in the brain to take a positive effect on smoking cessation. Patients very often describe the occurrence of: abnormal dreams, insomnia (sleep disturbances),cephalgia (headache) and nausea (nausea) while taking varenicline. Other common side effects include: Vertigo (dizziness), fatigue, and gastrointestinal symptoms. Contraindications exist for pregnant women, children and young adults, and smokers with mental illness (due to reports of suicidal thoughts and actions by smokers with mental illness). The use of varenicline is usually limited to 12 weeks and may be taken only after medical consultation.
Possible complications
Nicotine replacement therapy
- When dosed correctly, only nicotine effects can be detected as adverse drug reactions.
Drug treatment
