example smoking cessation
TRANSCRIPT
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Comparative EfficacyComparative Efficacyof Secondof Second--line drugsline drugs
for Smoking cessationfor Smoking cessation
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OutlineOutline
Introduction
Second-line drugs f or smoking cessation- Nortriptyline
- ClonidineConclusions
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Introduction
å úøë öéâå ø â ãèéââ ûû
- 42,000 å ú/ü - 115 å ú/ ú- 5 å ú/ë è
ý ü ø õ ûâ úéêü úèüõ üô 10,000å úöü ø : ÷öù
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Henningf ield et al, Epidemio
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âââöõû
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Quitting methods
Cold turkey Counseling /behavioral therapy
- Individual - Group - Telephone
Pharmacological therapy-Replacement therapy eg.nicotine
-Reduction of withdrawal
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Pharmacological Treatment
First-line drugs f or smoking cessations
Nicotine replacement therapy (NRT)Patch
GumInhaler
Nasal spray
Lozenge
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Pharmacological Treatment
Second-line drugs f or smoking cessations
Clonidine
Nortript
yline
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Other medications
SSRIs
MAOIs
Mecamylamine
Anxiolytics
Opioids antagonists Silver acetate
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Nortriptyline
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NortriptylineTricyclic
antidepressantsUS-FDA has not
approved
use
in
smoking cessation
The US Public Health Service (USPHS) :
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øù øè ë øNortript
yline
û èââ ûâ û ü
ûøâìõå úèãèâ÷ú
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ëéúöOnset : 2 wk
Bioavailability :65%âéýúâ ã ûâ øèú úõ
ü úÿø ö û : CY P 2D6
ã ûâøèü
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ãúõ
ùë õãúõ 25 mg/day
å ÿ éúüú75-100mg/dayúå è ûèú 4
å èå ö èö 10-28 úâúúø
éâû
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âÿ è
üèåâèèúú üâè öÿ
úõ ú üå èøèýâéöúüúéè åõú öè orthostatichypotension
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Addiction 2005;100:317-326
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ã å è
åéõõ üöüå è öââö
åëâ ý üø å èöâëâ ý ø åöû
âëâû MAOIs éøâõâëâø úè ãè éöúé å
Pre nanc cate or : D
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ý ø ÿ è úöéââ ý ø ÿ
ã ë
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Eff icacy o
f Nortriptyline
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ú å ÿøAbstinence rate :öââû
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Cochrane 2004
Wagena 2004
âüûø
û
Nortriptyline VS Placebo
Nortriptyline VS Placebo
éúútrial
7 5
éúúsubject1,021 å ú 861 å ú
â
èú 6 õú èú 6 õú
öèüûøûââ
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Antidepressants f or smoking c
The Cochrane Librar
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Nortriptyline is more more eff icaciouseff icacious than placebo
Pooled odd ratio = 2.14The Cochrane Librar
Antidepressants f or smoking c
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Cochrane 2004
Wagena 2004
âüûø
û
Nortriptyline VS Placebo
Nortriptyline VS Placebo
éúútrial
7 5
éúúsubject1,021 å ú 861 å ú
â
6-12 õú èú 6 õú
öèüûøûââ
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Eff icacy of nortriptyline compared with placebo af ter at least 6-month prolonged abstinence f rom smoking
Nortriptyline is more more eff icaciouseff icacious than placebo
RR = 2.44 (95%CI :Addiction
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0
10
20
3040
50
% A
s t i
t r a
t e
12 24 36 52
ti e eek)Bupropion
Nortript line
P l ebo
øû % A sti ent rateè BupropiNortrityline Place o úöë è
Arch Gen Psychiatry.
Psychological Intervention and Antidepressant Treatment in Smok ing C
essatio
n
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Clonidine
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C lonidine
Alpha-2 adrenergic
agonistAn antihypertensive agent
The US Public Health Service (USPHS) :second-line drug in
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øù øè ë ø
âö ú peripheral alpha-adrenergic receptors
vasoconstriction û èâüø
sympathetic éâ CNS å õ ú
öõè
âö úãè
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ëéúö
Bioavaila
bility
:7
5-
95% å ãã úèõãè - oral : 2-4 ë è
- patch
: 2-
3 ú ýúâã ûâøèú ú ü úÿø ö ûüô 50
ã ûøèü 65-72 , øèéé 22 å å èëöãè
-å
úüâö : 6-20 ë è
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Tablet
Patch
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âõ
ë å õãúõ õú 2-4 ú ÿ â èâ÷ú
ø éâõã ú ë ú âûâ é ú ú ú û üõ
è â éöú å ú üõâú
â÷úââõúý ø ë
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âÿ èüèå> 10% : üâè è è
ì úèè
1-10% : øèýâ ú üõ õø üâú éü
è ýúü ââ ã
úãúõö ø õ éè
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ã åè ã ë õèâë ú severe coronary
insuff iciency
recent MI cerebrovascular disease chronic renal f ailure
Pregnancy category : C ë úý ø üöÿ
ûèéâõ öèü ú
ü øùÿãè
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Eff icacy o
f C
lonidine
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Clonidine is moreefficacious than placebo
P l r ti = 1.The Cochrane
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Twenty-four week maintenance treatment of cigarette
smoking with nicotine gum, clonidine and naltrexone
Abstinence rate at 6 month
36.819.3
5.30
20
40
60
80
100
nicotine gum clonidine naltrexone
Dugs
A b s t i n e n c e r a t e
Journal of Substance Abuse Tr
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Dose(mg/day)
Cost/day
(Bath)
Cost/month
(Bath)
Nicotine gum
(2 g)
60(~15
ë ú)
105 3,150
Bupropion
300 58 1,740Nortri ø : úããõúëôò
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C onclusion
Eff icacy of Nortriptyline &Clonidine > placebo
Clonidine not more eff icacious than NRTNortriptyline : eff icacy of
nortriptyline ~ bupropionNortriptyline might be f irst-line drugs f or smoking cessation
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Special
Thanksé ø üâõ. ëõ ÿ úù