Abstract
Due to the profound mortality associated with tobacco use, effective treatments for tobacco dependence are needed. Currently, the most widely available pharmacotherapy is nicotine replacement therapy (NRT). This paper will review the state of the science and public health policy regarding NRT.
Several formulations have been developed for delivering nicotine into the body, including nicotine patch, gum, oral inhaler, nasal spray, and lozenge. Nicotine patches deliver nicotine at a relatively steady rate and are applied once daily. All other forms are taken on a periodic basis, multiple times per day. All of these products, except the nasal spray, deliver nicotine through the oral mucosa. New formulations are currently in the development phase. There are also several ways in which currently available formulations could be modified to improve delivery. The future of NRT may include the development of a true pulmonary inhaler, products for long-term maintenance, products for reduced smoking, products for acute use, and the tailoring of treatments for individual smokers. Nicotine replacement medications have been shown to be efficacious in dozens of clinical trials, and have had an impact on public health by assisting thousands of smokers to quit smoking. The over-the-counter marketing of nicotine patches and gum allows smokers ready access to these medications, and has led to an increase in product use and successful cessation compared with prescription-only marketing. The wide menu of NRT medications for smoking cessation gives patients and healthcare professionals options for treatment. However, whereas NRT medications double quit rates compared with unassisted attempts, there is clearly much to be done to improve the proportion of quitters who use evidence-based treatment, their use of the products, and the usability and inherent efficacy of NRT.
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Acknowledgements
Dr Henningfield was supported by an Innovators Combating Substance Abuse Award from the Robert Wood Johnson Foundation.
Drs Shiffman, Fant, Gitchell, Cone, and Henningfield serve as consultants to GSKCH on an exclusive basis regarding matters relating to smoking cessation. Drs Shiffman, Gitchell, and Henningfield also have an interest in a new nicotine replacement product. Dr Fagerström has worked full time for Pharmacia up to 1998, a manufacturer of nicotine replacement medications, and has since consulted for other manufacturers/marketers of nicotine replacement medications (GSKCH, Novartis, and Ceejay Healthcare). Dr Fagerström also has stock in a company developing nicotine replacement medications.
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Shiffman, S., Fant, R.V., Gitchell, J.G. et al. Nicotine delivery systems. Am J Drug Deliv 1, 113–124 (2003). https://doi.org/10.2165/00137696-200301020-00003
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DOI: https://doi.org/10.2165/00137696-200301020-00003