Increasing the diversity and availability of medications for the treatment of
tobacco dependence and/or withdrawal, to aid in the achievement of smoking cessation, is crucial to meet the diverse needs of tobacco users. Despite a general awareness that smoking is harmful and widespread interest in smoking cessation, nearly 50 million adults in the US and 1.3 billion worldwide continue to
smoke.
Nicotine replacement therapies are effective in the treatment of
tobacco dependence and withdrawal, but do not meet the needs of all tobacco users. Improvement of
tobacco dependence and/or withdrawal treatments is likely to rely on novel pharmacological approaches that include new chemical entities and new formulations of current drugs. In addition, new indications for treating
tobacco dependence and withdrawal show promise for reducing tobacco use and associated disease. This article focuses on a range of novel pharmacological approaches for the treatment of
tobacco dependence and/or withdrawal, including oral and pulmonary
nicotine delivery and the following non-nicotinic medications:
antidepressants, an alpha4beta2
nicotine partial agonist, an alpha2-noradrenergic agonist,
cytochrome P450 (CYP) 2A6 inhibitors,
opioid antagonists and GABAergic medications. In addition to existing medications, this article addresses novel medications in the clinical development stage and those that have been evaluated previously. Novel medications in the clinical development stage include at least three
nicotine vaccines and the
cannabinoid receptor acting
drug rimonabant. Medications evaluated previously include
lobeline,
mecamylamine and an
anticholinergic drug regimen comprising
atropine,
scopolamine and
chlorpromazine. Having not been approved by major
drug regulatory authorities for the treatment of
tobacco dependence and/or withdrawal, these medications have been evaluated in an experimental capacity.