Abstract
BackgroundMany effective treatments for nicotine addiction inhibit noradrenaline reuptake. Three recent studies have suggested that another noradrenaline reuptake inhibitor, atomoxetine, may reduce smoking behaviors.MethodsThe present double-blind, placebo-controlled, fixed-dose study was carried out over 21 days during which administration of 40 mg atomoxetine was compared to placebo in 17 individuals. Of these, nine were randomized to atomoxetine and eight to placebo. Baseline and weekly measurements were made using the Cigarette Dependence Scale (CDS), Cigarette Withdrawal Scale (CWS), Questionnaire of Smoking Urges (QSU), reported number of cigarettes smoked, and salivary cotinine levels.ResultsThe study results showed that all those on placebo completed the study. In marked contrast, of the nine individuals who started on atomoxetine, five dropped out due to side effects. In a completer analysis there were statistically significant differences at 14 and 21 days in several measures between the atomoxetine and placebo groups, including CDS, CWS, QSU, number of cigarettes smoked (decreasing to less than two per day in the treatment group who completed the study), and a trend towards lower mean salivary cotinine levels. However, these differences were not seen in a last observation carried forward (LOCF) analysis.ConclusionsIn summary, this is the first study to examine the use of atomoxetine in non-psychiatric adult smokers for a period of more than 7 days, and the findings suggest that atomoxetine might be a useful treatment for nicotine addiction. However, the dose used in the current study was too high to be tolerated by many adults, and a dose-finding study is required to determine the most appropriate dose for future studies of this potential treatment for smoking cessation.
Highlights
Smoking is recognized as a global concern
Several studies have demonstrated that alterations in noradrenaline (NA) neurotransmission are a contributor to the process of nicotine dependence [3,4,5], smoking maintenance [6], relapse [7], and withdrawal [3]
When the last observation carried forward (LOCF) measurements were made, the differences between the groups were no longer statistically significant. These results suggest that those study participants who completed the study and received atomoxetine may have experience a reduction in their nicotine withdrawal symptoms compared to those who received placebo, but the data is by no means clear in this regard
Summary
Nicotine addiction affects tobacco users, and their families and society in general. Impacting both mental and physical health, smoking addiction generates high costs associated with multidimensional measures, significantly affecting economy of countries worldwide [1]. For several decades researchers have been attempting to find effective therapies for smoking cessation. Several studies have demonstrated that alterations in noradrenaline (NA) neurotransmission are a contributor to the process of nicotine dependence [3,4,5], smoking maintenance [6], relapse [7], and withdrawal [3]. Many effective treatments for nicotine addiction inhibit noradrenaline reuptake. Three recent studies have suggested that another noradrenaline reuptake inhibitor, atomoxetine, may reduce smoking behaviors
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