Piotr Tutka

Zespół palenia tytoniu - choroba wymagająca leczenia

Tobacco dependence - a disease which needs treatment. Approximately 80% of smokers desire to quit smoking but only a mere few percent achieve success. Thus, the necessity of medical intervention in the clinical management of smoking cessation is warranted. The presence of effective drugs on the pharmaceutical market is an important part of such management. Among currently available anti-smoking drugs, the first-line pharmacotherapy is: bupropion (available as tablets), and nicotine replacement therapy (NRT) (available as chewing gums, patches, lozenges, nasal aerosols, and inhalators). In smokers making an attempt to quit, bupropion and NRT increase 12-month continuous abstinence rates by 5-14%. Despite the efficacy, their use (especially bupropion) is limited due to cost of therapy posing an economic barrier for many smokers. Clonidine and nortriptyline are recommended as the second-line anti-smoking drugs; both however can exert serious side effects. Recently, two partial agonists of nicotinic -4-2 receptors, cytosine and varenicline have been proposed as alternative pharmacological options to assist in achieving smoking cessation. Both drugs have pharmacological characteristics similar to nicotine. They limit the psychogenic reward from nicotine obtained through smoking, decrease craving and attenuate nicotine withdrawal symptoms that often precipitate relapse. Recent uncontrolled trial conducted in Poland on 436 smokers confirmed the previously reported efficacy of cytisine - the 12-week continuous abstinence rate was 27%. In addition to being efficacious, cytisine seems to be safe. The obvious advantage of the drug is its low cost, which could make it an effective treatment for millions of smokers. Varenicline, which is cytisineęs derivative, was introduced as a smoking cessation aid in 2006. The first studies on varenicline as a smoking cessation aid have suggested that the drug is highly efficacious (with 31-44% abstinence rate at 12 week) and well-tolerated. Thus, varenicline may soon become the first-line pharmacotherapy for tobacco dependence. The encouraging results have been also seen in the clinical studies that have been reported with rimonabant, and nicotine vaccines.