The evolving pharmacotherapy of smoking cessation.

Abstract

Over a decade has passed since the first nicotine-replacement product appeared on the U.S. market. In 1984, nicotine gum became the first medication of any type approved for smoking cessation by the Food and Drug Administration, and it revolutionized therapy. Over the next 13 years, other nicotine products followed—transdermal patches in 1992, a nasal spray in 1996, and an inhaler in 1997. Even newer ways to deliver nicotine into the bloodstream, including a sublingual tablet, a lozenge, and a nicotine “lollipop,” are in development. In the meantime, the nicotine patch and gum have become mainstays of treatment. Their efficacy is supported by the results of multiple randomized controlled trials and, more recently, by a series of meta-analyses which demonstrate that the patch more than doubles the likelihood of long-term success in a smoking cessation attempt, while the gum increases cessation rates by 50% to 60%.1–3 In 1996, an evidence-based clinical guideline for smoking cessation from the Agency for Health Care Policy and Research established nicotine replacement as the standard of care, concluding that both the nicotine patch and gum were effective and recommending that, “except in the presence of serious medical precautions, the clinician should encourage the use of nicotine replacement with patients who smoke.”4 Nonetheless, unanswered questions remain about the use of these products. Two articles in this issue of JGIM address questions about the nicotine patch: the generalizability of its benefit to disadvantaged populations and its value in blunting the weight gain that follows smoking cessation.