Smoking Cessation Intervention, Article Review Example

Abstract

This study examines the use of the medication Varenicline in smoking cessation therapy. Findings show that Varenicline is effective due to its physiological effects on the dopamine receptors of the individual who is attempting to quit the use of tobacco. More studies are needed across a broader range of demographics for determining the precise effectiveness and efficacy of the use of Varenicline as a smoking cessation intervention.

Introduction

The article written by Apelberg, Onicescu, Avila-Tang and Samet (2010) reports a study that compared potential population-wide benefits and risks by examining the potential impact of increased nicotine replacement therapy (NRT) use for smoking cessation on future US mortality. The study methodology involved the use of data from 2005 National Health Interview Survey (NHIS) to estimate the prevalence of smoking among  adults or those who are 19 years of age or older. Reports state that there are concerns about the long-term use of nicotine replacement therapy and it is reported that this might result in a reduction in the cessation-related benefits of nicotine replacement therapy-aided quit attempts. However, risk posed by tobacco smoke includes exposure to toxic compounds that may potentially damage the cardiovascular system and clinical trials “have generally shown NRT use to be safe.” (Joseph, Norman and Fairy, 1996; and Haustein, 1999 in: Apelberg, Onicescu, Avila-Tang and Samet, 2010) There are however, three available treatment options for those who desire to quit tobacco use. The three classes of medications that have been FDA approved for use in smoking cessation includes: (1) nicotine replacement therapy; (2) bupropione; and (3) varenicline. (Apelberg, Onicescu, Avila-Tang and Samet, 2010)

Comparison of FDA Approved Drug Interventions

The first of these medication is that of nicotine replacement therapy stated to provide “…a less addictive and safer form of nicotine than cigarettes.” (Tonstad, 2010)The second of these is the medication bupropion reported to have been introduced in the beginning as an antidepressant and later discovered to be effective for smoking cessation. Bupuprion acts through increasing dopaminergic and noradrenergic tone and additionally is believed to act as a “weak antagonist at nAChRs and in combination to result in a reduction in nicotine cravings and a reduction in positive reinforcement provided by nicotine during a relapse.” (Tonstad, 2010) The third medication is that of Varenicline reported to be a medication that was specifically developed as an “…a432 nAChR partial agonist for smoking cessation based on the discovery that a432 containing nAChRs play a key role in mediating addiction to nicotine.” (Tonstad, 2010) Varenicline provides nicotine like effects that result in relieving craving along with restlessness but however that does not relief symptoms such as anxiety, depression and insomnia. (Tonstad, 2010, paraphrased) Inhaled nicotine is blocked in terms of its effects since the “target receptors are occupied by Varenicline, which attenuates the rewarding and satisfying effects of nicotine during smoking.” (Tonstad, 2010) Varenicline is so effective because it binds with “high affinity to human a432 nAChRs. Inhaled nicotine is rapidly dispersed from the lungs to the brain and then interacting with high-affinity nAChRs resulting in “almost immediate changes in dopamine” which is a contributor to nicotine dependence development since the nicotine causes a “dopamine-induced activation that results in feeling of reward or positive reinforcement. When dopamine is released, the individual experiences sensations of pleasure. The effects provided by nicotine use are reported to be “mediated via central nAChRs, pentameric ligand-gated ion channels composed of a- and/or B-subunits that mediate fast synaptic neurotransmission.” (Tonstad, 2010) The clinical efficacy of Varenicline has been demonstrated and reports state that Varenicline has resulted in smoking cessation in approximately 6,000 daily cigarette smokers in trials.

Varenicline has been approved worldwide by regulatory authorizes for use in smoking cessation with a recommended dosage of one milligram twice per day. During the first week of Varenicline use the dose starts at 0.5 mg once per day on days 1 through 3 and then given twice per day on days 4 through 7 with a full dosage reached by day 8, stated to generally be the date targeted to quit smoking by the smoker and their physician. Varenicline treatment is generally a 12-week period. This is because clinical trial data show that “…the point prevalence quit rates increase rather than flatten out during the initial weeks of treatment” indicating that patients who have not be able to stop on the chosen quit day should receive encouragement to make additional attempts to quit tobacco use during the next five to six weeks of the treatment period…. (Tonstad, 2010) Varenicline has been found to be superior to nicotine replacement therapy in some studies however; combination NRT therapy is stated to have been found superior to treatment with Varenicline

Limitations in Research

To date there are no demographic variables associated with Tobacco Use – Review of Interventions for Smoking Cessation Varenicline’s effectiveness for smoking cessation. In addition, it is reported that no placebo-controlled studies have been conducted for the purpose of comparing Varenicline with nicotine replacement therapy. The U.S. Food and Drug Administration issued a public health advisory in February of 2008 that reported that based on “post marketing signals, severe changes in mood and behavior may be related to Varenicline.” (Tonstad, 2010) This advisory was updated later in 2008 and the FDA stated that physicians prescribing this medication should closely monitor patients for mood and behavior changes and worsening of any psychiatric illnesses that are pre-existing in the patient using Varenicline to quit smoking.

What Has Been Learned

The examination of the use of Varenicline in smoking cessation has been informative in that it has been learned in this study that Varenicline is very effective since it bonds with “high affinity to human a432 nAChRs. Because of this Varenicline has been found to be superior to Nicotine-replacement therapy. In addition, Varenicline has been approved throughout the world by regulatory authorities for use in smoking cessation. Varenicline treatment lasts approximately 12 weeks. It has also been learned in this study that findings indicate that patients who are not able to stop smoking on the designated ‘quit day’ are in need of encouragement to make further attempts to quit using tobacco during the five to six weeks following the designated ‘quit date’.

Varenicline has been approved worldwide by regulatory authorities for use in smoking cessation with a recommended dosage of one milligram twice per day. During the first week of Varenicline use the dose starts at 0.5 mg once per day on days 1 through 3 and then given twice per day on days 4 through 7 with a full dosage reached by day 8, stated to generally be the date targeted to quit smoking by the smoker and their physician. Varenicline treatment is generally a 12-week period. This is because clinical trial data show that “…the point prevalence quit rates increase rather than flatten out during the initial weeks of treatment” indicating that patients who have not be able to stop on the chosen quit day should receive encouragement to make additional attempts to quit tobacco use during the next five to six weeks of the treatment period….”(Tonstad, 2010) Varenicline has been found to be superior to nicotine replacement therapy in some studies however; combination NRT therapy is stated to have been found superior to treatment with Varenicline. Combination NRT therapy is however more effective that treatment with Varenicline.

Summary and Conclusion

Varenicline has been found to be effective in treating individuals who desire to quit smoking and this is likely because of the physiologic properties of the medication’s effects on the human dopamine receptors. There is a requirement for the conduction of more research on Varenicline to determine the actual effectiveness across all demographics and in determining whether the side effects outweigh the benefits of this medication.

References

Tonstad, Serena (2010) Varenicline in Smoking Cessation. Expert Rev. Resp. Med. 4(3), 2910299 (2010).

Apelberg, B.J., Onicescu, G., Avila-Tang, E. and Samet, J.M. (2010) Estimating the Risks and Benefits of Nicotine Replacement Therapy for Smoking Cessation in the United States.February 2010, Vol 100, No. 2 | American Journal of Public Health.

Haustein KO. Smoking tobacco, microcirculatorychanges and the role of nicotine. Int J Clin PharmacolTher. 1999;37(2):76–85.

Joseph AM, Norman SM, Ferry LH, et al. The safetyof transdermal nicotine as an aid to smoking cessation inpatients with cardiac disease. N Engl J Med. 1996;335(24):1792–1798.