Skip to Main Content

Source: Doering PL, Li RM. Substance-Related Disorders: Alcohol, Nicotine, and Caffeine. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7987625. Accessed June 9, 2012.

  • Nicotine-related substance abuse involves dependence and withdrawal.
  • Physical dependence: state of adaptation manifested by withdrawal syndrome following:
    • Cessation
    • Rapid dose reduction
    • Decreasing blood levels
    • Administration of antagonist
  • Withdrawal:development of substance-specific syndrome following cessation or reduced intake of substance that had been used regularly.

  • Nicotine is ganglionic cholinergic-receptor agonist with dose-dependent pharmacologic effects.
  • Effects include:
    • CNS and peripheral nervous system stimulation and depression
    • Respiratory stimulation
    • Skeletal muscle relaxation
    • Catecholamine release by adrenal medulla
    • Peripheral vasoconstriction
    • Increased blood pressure, heart rate, cardiac output, and oxygen consumption
  • Low doses of nicotine increase alertness and improve cognitive functioning.
  • Higher nicotine doses stimulate “reward” center in limbic system.
  • Cigarette smoking leading cause of preventable morbidity and mortality in United States. It increases the risk of:
    • Cardiovascular diseases
    • Lung cancer
    • Other cancers (e.g., bladder, kidney, pancreatic, esophageal, stomach, and head & neck cancers)
    • Nonmalignant respiratory diseases

  • In a 2007 study, 28.6% of US population 12 years of age and older (70.9 million people) used tobacco product at least once in month prior to being interviewed.
  • Approximately 20% of high school students (43.8 million) currently smoke on regular basis.
  • Smoking method data
    • ~60 million Americans smoke cigarettes
    • 13.3 million smoke cigars
    • 8.1 million use smokeless tobacco
    • 2 million smoke pipes

Signs and Symptoms

  • Abrupt cessation of chronic nicotine use usually results in onset of withdrawal symptoms within 24 hours.
  • Withdrawal symptoms include:
    • Anxiety
    • Cravings
    • Difficulty concentrating
    • Frustration
    • Irritability
    • Hostility
    • Insomnia
    • Restlessness

  • Cessation of nicotine use
  • Resolution of withdrawal symptoms
  • Avoidance of side effects from pharmacologic therapies

  • Every smoker should receive at least minimal intervention at every clinician visit.
  • Interventions more effective when they:
    • Last >10 minutes
    • Involve contact with multiple types of clinicians
    • Involve at least 4 sessions
    • Provide nicotine-replacement therapy
  • Group and individual counseling effective, and interventions more successful when they include:
    • Social support and training in problem solving
    • Stress management
    • Relapse prevention
  • First-line pharmacotherapies for smoking cessation
    • Bupropion sustained release
    • Nicotine gum, inhaler, lozenges, nasal spray, or patch
    • Varenicline
    • Consider combinations if single agent failed.
  • Second-line pharmacotherapies for smoking cessation
    • Clonidine
    • Nortriptyline

  • Figure 1: Model for treatment of tobacco use and dependence

Figure 1.

Model for treatment of tobacco use and dependence. Reprinted with permission from Doering PL, Li RM. Chapter 75. Substance-Related Disorders: Alcohol, Nicotine, and Caffeine. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011.

  • Table 1: Pharmacologic agents for smoking cessation
  • Nicotine replacement therapy
    • Use of this modality doubles odds of successfully quitting compared to placebo.
    • Use with caution in patients within 2 weeks post-myocardial infarction, those with serious arrhythmias, and those with serious or worsening angina.
    • Nicotine ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.