Drug Safety

, Volume 8, Issue 1, pp 49–56 | Cite as

Risk-Benefit Assessment of Nicotine Preparations in Smoking Cessation

  • John R. Hughes
Review Article Risk-Benefit Assessment

Summary

Nicotine influences many risk factors for cardiovascular disease, peptic ulcer disease, pregnancy complications and wound healing; however, whether nicotine itself actually causes or aggravates these diseases has not been well demonstrated. The safety of nicotine preparations for smoking cessation depends on the population, formulation, route of administration, dose, and frequency and duration of use. Major adverse effects of nicotine polacrilex and transdermal nicotine are very rare. Nicotine therapy usually doubles long term abstinence rates and is especially beneficial to highly dependent smokers. Nicotine replacements produce lower nicotine concentrations than cigarettes, and no tar and carbon monoxide; thus, it is difficult to justify absolute contraindications to these products. Decisions on the use of nicotine preparations in pregnancy, coronary disease, etc., must consider not only the medical status of patients but also their likelihood of stopping smoking with and without the help of nicotine replacement.

Keywords

Nicotine Smoking Cessation Nicotine Dependence Nicotine Replacement Therapy Dependent Smoker 

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References

  1. American Psychiatric Association (Eds). Diagnostic and statistical manual of mental disorders, 3rd ed. revised, American Psychiatric Association, Washington, 1987Google Scholar
  2. Belcher M, Jarvis MJ, Sutherland G. Nicotine absorption and dependence in an over the counter aid to stopping smoking. British Medical Journal 298: 570, 1989PubMedCrossRefGoogle Scholar
  3. Benowitz NL. Clinical pharmacology of nicotine. Annual Review of Medicine 37: 21–32, 1986PubMedCrossRefGoogle Scholar
  4. Benowitz N. Toxicity of nicotine: implications with regard to nicotine replacement therapy. In Pomerleau & Pomerleau (Eds) Nicotine replacement: a critical evaluation, pp. 187–217, Alan R. Liss, Inc., New York, 1988aGoogle Scholar
  5. Benowitz NL. Pharmacologic aspects of cigarette smoking and nicotine addiction. New England Journal of Medicine 319: 1318–1330, 1988bPubMedCrossRefGoogle Scholar
  6. Benowitz NL. Central nervous system toxicity of nicotine. In Wald & Froggatt (Eds) Smoking and the low tar programme, pp. 5–10, Oxford University Press, Oxford, 1989Google Scholar
  7. Benowitz NL. Nicotine and coronary heart disease. Trends in Cardiovascular Medicine 1: 315–321, 1991aPubMedCrossRefGoogle Scholar
  8. Benowitz NL. Nicotine replacement therapy during pregnancy. Journal of the American Medical Association 266: 3174–3177, 1991bPubMedCrossRefGoogle Scholar
  9. Breslau N, Kilbey MM, Andreski P. Nicotine dependence, major depression, and anxiety in young adults. Archives of General Psychiatry 48: 1069–1074, 1991PubMedCrossRefGoogle Scholar
  10. Christen AG, McDonald Jr JL. Safety of nicotine-containing gum. In Pomerleau et al. (Eds) Nicotine replacement: a critical evaluation, pp. 219–235, Alan R. Liss, Inc., New York, 1988Google Scholar
  11. DeGrandpre RJ, Bickel WK, Hughes JR, Higgins ST. Behavioral economics of drug self-administration III: reanalysis of the nicotine regulation hypothesis. Psychopharmacology 108: 1–10, 1992PubMedCrossRefGoogle Scholar
  12. Fagerstrom K-O. Efficacy of nicotine chewing gum: a review. In Pomerleau et al. (Eds) Nicotine replacement: a critical evaluation, pp. 109–128, Alan R. Liss, Inc., New York, 1988Google Scholar
  13. Fagerstrom K-O, Hurt RD, Sawe U, Tonnesen P. Therapeutic use of nicotine patches: efficacy and safety. Journal of Smoking-Related Diseases, in press, 1992Google Scholar
  14. Fagerstrom K-O, Schneider NG. Measuring nicotine dependence: a review of the Fagerstrom tolerance questionnaire. Journal of Behavioral Medicine 12: 159–182, 1989PubMedCrossRefGoogle Scholar
  15. Fiore MC, Novotny TE, Pierce JP, Hatzeandreu EJ, Patel KM, et al. Trends in cigarette smoking in the United States: the changing influence of gender and race. Journal of the American Medical Association 261: 49–55, 1989PubMedCrossRefGoogle Scholar
  16. Glassman AH, Heizer JE, Covey LS, Cottier LB, Stetner F, et al. Smoking, smoking cessation, and major depression. Journal of the American Medical Association 264: 1546–1549, 1990PubMedCrossRefGoogle Scholar
  17. Hajek P, Jarvis MJ, Belcher M, Sutherland G, Feyerabend C. Effect of smoke-free cigarettes on 24h cigarette withdrawal: a double-blind placebo-controlled study. Psychopharmacology 97: 99–102, 1989PubMedCrossRefGoogle Scholar
  18. Hale KL, Hughes JR, Oliveto AH, Heizer JE, Higgins ST, et al. Nicotine dependence in a population-based sample. In Harris (Ed.) Problems of drug dependence 1992, NIDA Research Monograph Series, US Government Printing Office, Washington, in press, 1992Google Scholar
  19. Hasenfratz M, Battig K. Nicotine absorption and the subjective and physiologic effects of nicotine toothpicks. Clinical Pharmacology and Therapeutics 50: 456–461, 1991PubMedCrossRefGoogle Scholar
  20. Henningfield JE, Woodson PP. Behavioral and physiological aspects of nicotine dependence: the role of nicotine dose. Journal of Substance Abuse 1: 301–317, 1989Google Scholar
  21. Hoffman D. Nicotine, a tobacco-specific precursor for carcinogens. In Wald & Froggatt (Eds) Nicotine, smoking and the low tar programme, pp. 24–39, Oxford University Press, Oxford, 1989Google Scholar
  22. Hughes JR. Problems of nicotine gum. In Ockene (Ed.) Pharmacologic treatment of tobacco dependence: Proceedings of the World Congress, November 3–5, 1985, pp. 141–147, Institute for the Study of Smoking Behaviour and Policy, Cambridge, Massachusetts, 1986aGoogle Scholar
  23. Hughes JR. Genetics of smoking: a brief review. Behaviour Therapy 17: 335–345, 1986bCrossRefGoogle Scholar
  24. Hughes JR. Dependence potential and abuse liability of nicotine replacement therapies. In Pomerleau et al. (Eds) Nicotine replacement in the treatment of smoking, pp. 261–278, Plenum Press, New York, 1988aGoogle Scholar
  25. Hughes JR. Clonidine, depression and smoking cessation. Journal of the American Medical Association 254: 2901–2902, 1988bCrossRefGoogle Scholar
  26. Hughes JR. Long-term use of nicotine-replacement therapy. In Henningfield & Stitzer (Eds) New developments in nicotine-delivery systems, pp. 64–71, Carlton Publishers, New York, 1991Google Scholar
  27. Hughes JR. Pharmacotherapy for smoking cessation: a brief review. Journal of Consulting and Clinical Psychology 60: 689–697, 1992PubMedCrossRefGoogle Scholar
  28. Hughes JR, Gust SW, Keenan RM, Skoog K, Fenwick JW, et al. Long-term use of nicotine versus placebo gum. Archives of Internal Medicine 151: 1993–1998, 1991PubMedCrossRefGoogle Scholar
  29. Hughes JR, Higgins ST, Hatsukami DK. Effects of abstinence from tobacco: a critical review. In Kozlowski et al. (Eds) Research advances in alcohol and drug problems, Vol. 10, pp. 317–398, Plenum Press, New York, 1990Google Scholar
  30. Jarvis MJ, Hajek P, Russell MAH, West RJ. Nasal nicotine solution as an aid to cigarette withdrawal: a pilot clinical trial. British Journal of Addiction 82: 983–988, 1987PubMedCrossRefGoogle Scholar
  31. Levine RL, Pepe PE, Fromm RE, Curka PA, Clark PA. Prospective evidence of a circadian rhythm for out-of-hospital cardiac arrests. Journal of the American Medical Association 267: 2935–2937, 1992PubMedCrossRefGoogle Scholar
  32. Levy LS, Martin PA. Toxicology of nicotine — its role in the aetiology of cancer due to cigarette smoking and cardiovascular disease. In Wald & Froggatt (Eds) Nicotine, smoking and the low tar programme, pp. 13–23, Oxford University Press, Oxford, 1989Google Scholar
  33. McNeil AD, West RJ, Jarvis M, Jackson P, Bryant A. Cigarette withdrawal symptoms in adolescent smokers. Psychopharmacology 90: 533–536, 1986CrossRefGoogle Scholar
  34. Newhouse P, Hughes JR. The role of nicotine and nicotine mechanisms in neuropsychiatric disease. British Journal of Addiction 86: 521–526, 1991PubMedCrossRefGoogle Scholar
  35. Palmer KJ, Faulds D. Transdermal nicotine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use as an aid to smoking cessation. Drugs 44: 498–529, 1992PubMedCrossRefGoogle Scholar
  36. Rennard SI, Daughton DM, Fortmann SP, Killen J, Petty T, et al. Transdermal nicotine enhances smoking cessation in coronary artery disease patients. Chest 100: 5S, 1991Google Scholar
  37. Russell MAH, Jarvis MJ, Sutherland G, Feyerabend C. Nicotine replacement in smoking cessation. Journal of the American Medical Association 257: 3262–3265, 1987PubMedCrossRefGoogle Scholar
  38. US Department of Health and Human Services. The health consequences of smoking for women: a report of the Surgeon General, Office on Smoking and Health, Rockville, 1980Google Scholar
  39. US Department of Health and Human Services. The health consequences of smoking: chronic obstructive lung disease. A report of the Surgeon General, Office on Smoking and Health, Washington, 1984Google Scholar
  40. US Department of Health and Human Services. Toxicity of nicotine. In The health consequences of smoking: nicotine addiction. A report of the Surgeon General, pp. 590–611, US Government Printing Office, Washington, 1988aGoogle Scholar
  41. US Department of Health and Human Services. The health consequences of smoking: nicotine addiction, US Government Printing Office, Washington, 1988bGoogle Scholar
  42. US Department of Health and Human Services. The health consequences of smoking cessation: a report of the Surgeon General, US Government Printing Office, Washington, DC, 1990Google Scholar
  43. West RJ, Jarvis MJ, Russell MAH, Feyerabend C. Plasma nicotine concentrations from repeated doses of nasal nicotine solution. British Journal of Addiction 79: 443–445, 1984PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1993

Authors and Affiliations

  • John R. Hughes
    • 1
  1. 1.Departments of Psychiatry, Psychology and Family PracticeUniversity of VermontBurlingtonUSA

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