Academic journal article Indian Journal of Psychiatry

Role of Nicotine Receptor Partial Agonists in Tobacco Cessation

Academic journal article Indian Journal of Psychiatry

Role of Nicotine Receptor Partial Agonists in Tobacco Cessation

Article excerpt

Byline: Nivedita. Maity, Prabhat. Chand, Pratima. Murthy

One in three adults in India uses tobacco, a highly addictive substance in one or other form. In addition to prevention of tobacco use, offering evidence-based cessation services to dependent tobacco users constitutes an important approach in addressing this serious public health problem. A combination of behavioral methods and pharmacotherapy has shown the most optimal results in tobacco dependence treatment. Among currently available pharmacological agents, drugs that preferentially act on the a4 [sz]2-nicotinic acetyl choline receptor like varenicline and cytisine appear to have relatively better cessation outcomes. These drugs are in general well tolerated and have minimal drug interactions. The odds of quitting tobacco use are at the very least doubled with the use of partial agonists compared with placebo and the outcomes are also superior when compared to nicotine replacement therapy and bupropion. The poor availability of partial agonists and specifically the cost of varenicline, as well as the lack of safety data for cytisine has limited their use world over, particularly in developing countries. Evidence for the benefit of partial agonists is more robust for smoking rather than smokeless forms of tobacco. Although more studies are needed to demonstrate their effectiveness in different populations of tobacco users, present literature supports the use of partial agonists in addition to behavioral methods for optimal outcome in tobacco dependence.


Tobacco, a human created epidemic is a major cause of preventable death and disease in the world. Nearly 35% of adults in India use some form of tobacco. India, with a population of 1.2 billion, currently has around 275 million tobacco users. Smokeless tobacco (SLT) use is more common than smoking. Morbidity and mortality related to tobacco use are both very high across the world, more so in developing countries. Smoking has been associated with reduction of median survival rate by 6-8 years. Tobacco-related mortality in India is among the highest in the world and 930,000 adult deaths in India were forecast due to smoking alone for 2010. [sup][1],[2] Excess deaths among smokers, as compared with non-smokers, were chiefly from tuberculosis and respiratory, vascular or neoplastic diseases. [sup][1] A recent large hospital based study from urban India has shown that current smokers have a relative risk (RR) of almost 4.7 times compared to never smoker for acute myocardial infarction. [sup][3] Although there is no systematic study, it is estimated that 8.3 million cases of coronary artery disease and chronic obstructive airway diseases are also attributable to tobacco each year. [sup][4]

Tobacco Cessation

Quitting tobacco at any stage of life in a tobacco user is known to be beneficial. The risk of cardiac events, blood pressure, chronic obstructive pulmonary disease (COPD), oropharyngeal cancer/precancerous lesion etc., decreases substantially and the risks become comparable with the non-smoker over the next 1 year following quitting. Smokers who quit before 50 years of age reduce their risk of dying in the next 15 years to half that of a continuing smoker. [sup][5] This holds true for pregnancy. If a potential mother quits smoking before becoming pregnant or within the first trimester of pregnancy, infant birth weight is likely to be the same as a non-smoker. [sup][4],[5]

However, quitting tobacco is not easy. Tobacco is easily available in various forms and its use is culturally well accepted. Nicotine, the active ingredient of tobacco, is highly addictive. Spontaneous quit attempts are very low. While a significant percentage of smokers have considered quitting, it has been suggested that only 2% of users quit on their own. [sup][1]

Tobacco cessation for a current tobacco user (most of whom are dependent) needs a proactive approach and provision of support for a quit attempt. …

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