NON-NICOTINE PHARMACOTHERAPIES FOR SMOKING CESSATION

Non-nicotine pharmacotherapies could be helpful to smokers who have philosophical objections to nicotine replacement therapy (NRT)or to smokers who fail NRT. Clonidine is the only non-nicotine medication that appears efficacious; however, this is true only in women. Mecamylamine, a nicotine blocker, has been unsuccessful due to side effects; however, it needs to be tested at lower doses, when given prior to cessation or when given after NRT. Naltrexone, an opioid blocker, has produced mixed results but, given its benign side-effect profile, deserves more testing. Anorectics appear not only to suppress weight gain but also increase abstinence in early trials; thus, testing in smokers with a history of large abstinence-induced weight gains is indicated. Buspirone, a non-sedating anxiolytic, has produced mixed results but given its benign profile, deserves more testing. Lobeline, a nicotine-like drug, and silver acetate, which imparts a bad taste to cigarettes, do not appear effective. Antidepressants given to non-selected smokers have not consistently improved cessation; however, these medications need to be tested in smokers with a depressed mood or past history of depression. Other drugs that have been inadequately tested include adrenocorticotrophin (ACTH), anticholinergics, beta-blockers, benzodiazepines, glucose and stimulants.