Transdermal Nicotine and Nasal Nicotine Administration as Smoking-Cessation Treatments

Abstract

Nicotine replacement is currently the only approved pharmacologic treatment for smoking cessation, and for several years, the only formulation available has been nicotine chewing gum. While placebo controlled trials have shown that nicotine gum increases success rates when used as an adjunct to a behavioral treatment program, overall abstinence rates 6–12 months after initial cessation remain low. In a recent review of several clinical studies by Fagerstrom1, abstinence rates averaged 26% with active gum treatment versus 16% with placebo gum. In an attempt to increase the magnitude of treatment effects, other routes of nicotine administration have been explored, including transdermal and intranasal routes. The hope is that an appropriate rate and dose of nicotine replacement can relieve smoking withdrawal symptoms and can greatly reduce the tendency of a smoker to relapse. However, one must be cautious to avoid a simplistic characterization of cigarette smoking. For example, while most people are aware that smoking is more than just a habit, it is also more complex than simply an addiction to nicotine, at least as that concept is often understood. In fact, both of these views are incomplete, and the development of effective treatments for smoking cessation may hinge on an understanding of the subtle interactions between conditioned cues and pharmacologic factors involved in the maintenance of smoking behavior. Before discussing the therapeutic application of both transdermal nicotine administration and nasal nicotine administration as adjuncts to smoking-cessation treatment, it will be helpful to review what we know about smoking and its relationship to nicotine dependence.