Drug Interactions During Smoking Cessation
11.1.12 Contraindications for the Use of Nicotine Products
Sometimes,onthebasisofmisconceptionsconcerningtheeffectsofnicotineonthecardio- vascularsystem,theprescribinginformationfornicotineproductslistsnumerouscontraindi- cationsandwarningsthatrequirerevision.Thevasoconstrictoreffectsinthenicotine-dependent smokerareattributablemoretotheinhaledcombustionproducts,includingCO,thantonico- tineitself [71] .Thesamethinkingalsopossiblyappliesfortheadministrationofnicotine products during pregnancy [72] . The contraindications listed include: recent myocardial infarction,cardiacarrhythmias,recentstrokeandunstableangina.Thefollowingarecur- rentlyregardedasrelativecontraindications:stableangina,severehypertension,cerebrovas- culardisease,vasospasms,severeheartfailure,hyperthyroidism,insulin-dependentdiabetes mellitus,acutegastrointestinalulcerationandsevererenalandhepaticimpairment.Additional relative contraindications listed for nicotine chewing gum include inlammation of the mouththroatoesophagus.Forthenicotinepatch,thelistincludeschronicgeneralisedderma- tologicaldisorderspsoriasis,chronicdermatitisandurticariaandforthenicotinenasal spraynosebleedandchronicdiseasesofthenose. Nicotineproductsarenotcurrentlyrecommendedforuseduringpregnancyandlacta- tion,unlessthewomanisunabletostopwithoutnicotineproducts,andonlyafterconsult- ingaphysicianhowever,see [73] .ItwasstatedinmanyexpertreviewsthatNRTisthe agentofchoiceforsmokingcessationinpregnancyasthesafetyofothertherapiesinpreg- nancyhavenotyetbeenproved [74] .However,italsoneedstobementionedthatwhile NRTavoidsexposuretothemyriadcompoundspresentintobaccosmoke,nicotineitself causesdamagetothedevelopingnervoussystem [75] .11.1.13 Nicotine Formulations as OTC Products
VariousnicotineformulationsaresoldasOTCproductsinseveralEuropeancountriese.g. patchandguminGermany.Therationaleisthatsmokersabsorbnicotinefromcigarettes in higher doses, developing higher blood levels than following administration of NRT productsseeSects. 11.1.2 – 11.1.6 ;Figs. 11.2 and 11.3 .Thecurrentregulatoryframework restrictsaccesstoNRTwithoutadequatelyconsideringthatthelikelyconsequencewillbe thecontinueddependenceontheuseofnicotine-containingtobacco,whichisextremely harmfulanduniversallyavailable.Withtheaimofachievingharmreductioninsmoking children, pregnant women and patients with cardiovascular diseases or diseases of the respiratorytracte.g.COPD,allthesecategoriesofpeopleshouldbepermittedtouse NRTnotonlyforsmokingcessation,butalsoforreducingthedailycigaretteconsumption toanoptimumof10cigarettesday.AcritiqueofthecurrentsituationintheUKwas publishedin2001byMcNeilletal. [76] . Inonelargemeta-analysis,theeffectsofprescriptionandOTCsettingswerecompared intermsoftheireficacyinachievingsmokingcessation.Thestudiescomparedtheuseof patchandgumformulationsofnicotine.OTCsuccessrateswereconsistentlyhigherthan prescriptionratesat6weeksforbothpatchOR=1.45;CI:1.05–1.98andgumOR= 2.92;CI:1.58–5.40,andremainedsigniicantat6monthsforthepatchOR=3.63;CI: 1.74–7.61butnotforgumOR=1.37;CI:0.73–2.58 [73] .AmongOTCandprescription gumusers,16.1vs.7.7wereabstinentat6weeksand8.4vs.7.7at6months,respec- tively.AmongOTCandprescriptionpatchusers,abstinencerateswere19.0vs.16.0 after6weeksand9.2vs.3.0after6months [77] .TheauthorsclaimthatNRTusewithin clinicalstudiesdoesnotfollow“real-world”prescriptionpractices.Indeed,manyphysi- ciansprescribeNRTproductstotheirsmokingpatientswithonlyafewcommentscon- cerningtheiradministrationanduse.Inthisway,lowersuccessrateswillbeachievedthan ifphysiciansprovidecomprehensiveadvicetotheirsmokingpatientsoverseveralconsul- tationscf. Chap.15 .Incontrast,themeta-analysisiscorrectinconcludingthatthereis nodifferenceineficacybetweenOTCand“real-world”prescribing.IftheOTCmethod ofsupplyingNRTweretobespreadacrosslargerpopulationsegments,thiswoulddra- maticallyincreasethenumberofabstainingsmokers,andthisinturnwouldhaveasub- stantialpublichealthimpact.IntheUnitedStates,a20increaseinquitrateswasachieved [78] .TheOTCmethodresultedinfewersmoking-attributabledeathsandinincreasedlife expectancy [79,80] .Worldwide,NRTmustbecomemoreaccessibletosmokersbyremov- ingregulatorybarrierse.g.France,Australia,Brazil,andearlyresultssuggestafavour- ablepublichealthimpact [81] .DifferencesbetweenEuropeancountriesconcerningthe saleofnicotineformulationsarelistedinTable 11.5 .Whilemostnicotineformulationsare OTCproducts,bupropionisavailableonlyonprescription. AninterestingquestioniswhetherthechangeinNRTsalesfromprescriptiontoOTC status affected smoking cessation. To assess this issue, the 1993–1999 Massachusetts TobaccoSurveyswereusedtocomparedatafromadultcurrentsmokersandrecentquit- tersbeforeandaftertheOTCswitch [83] .Interestingly,nosigniicantchangeovertime occurredintheproportionofsmokerswhousedNRTataquitattemptinthepastyear 20.1pre-OTCvs.21.4post-OTC,madeaquitattemptinthepastyear48.1vs. 45.2,orquitsmokinginthepastyear8.1vs.11.1.Fewernon-WhitesusedNRT aftertheswitch20.7pre-OTCvs.3.2post-OTC,p=0.002,buttheproportionof WhitesusingNRTdidnotchangesigniicantly20.6vs.24.0.Itwasthereforecon- cluded that there may be no increase in smokers’ rates of using NRT, making a quit attempt,orstoppingsmokingafterNRTbecameavailableforOTCsale.Thereappearto beotherbarrierstotheuseofNRTbesidesvisitingaphysician,especiallyamongminor- itysmokers [83] .Parts
» Tobacco Plants and Their Origin Use of Tobacco for Religious Purposes
» The Appropriation of Tobacco by Europeans
» Development of the Cigarette
» Objections to Smoking on Health Grounds
» Women Won Over by the Cigarette
» The Medical Use of Tobacco in the Nineteenth Century
» Tobacco Research in the Twentieth Century
» Tobacco Consumption in the Twentieth Century
» Cigarette Smoking in the USA Since 1965
» Cigarette-Related Mortality in Different Countries
» Smokers and Other Risk Factors
» Smoking Behaviour and Educational Level in the EU
» Non-Disclosure of Findings by the Tobacco Industry
» The Cigarette as a Vehicle for Nicotine Release
» Modifications of Nicotine Release
» Maintaining Nicotine Dependence Nicotine and Dependence
» Marketing of Cigarettes with a “Reduced” Health Risk
» Compensatory Behaviour by Smokers
» Optimising Nicotine Release Nicotine and Dependence
» Importance of Absorption Rate
» Ammonium and pH Manipulation
» Cigarettes with Reduced Tar Yield
» Agonists and Antagonists of the nAChR and its Subtypes
» Effects of Nicotine on Receptors in Different Organs
» Metabolic and Hormonal Effects of Nicotine
» Central Nervous System Effects of Nicotine
» Types of Dependence Nicotine Dependence
» Molecular Biological Aspects of Dependence
» Genetic Aspects Nicotine Dependence
» Withdrawal Symptoms Nicotine Dependence
» Immunological Reactions Caused by Cigarette Smoking
» Association Between Smoking and Lung Cancer
» Tobacco-Specific Carcinogens Genetic Factors That Increase the Risk for Bronchial Carcinoma
» The Cytochrome P450 and GST System and Carcinogenesis
» Peptide Receptors, Genetic Factors That Increase the Risk for Bronchial Carcinoma
» Exogenous Factors and Lung Cancer
» Pathophysiology of COPD Cigarette Smoking and COPD
» Genetic Factors Important Risk Factors for COPD
» Occupational and Environmental Factors
» Caveats Concerning the Informative Value of Studies
» Cigarette Smoking and Bronchial Asthma in Adults
» Bronchial Asthma in Children
» Other Lung Diseases Influenced by Cigarette Smoking
» Coronary Artery Disease and Myocardial Infarction
» Changes in Endothelial Function and Microcirculation
» Microcirculation and O Systemic Vascular Changes
» Arteriosclerotic and Inflammatory Vascular Reactions
» Genetic Factors Blood Coagulation and Fibrinolysis
» Nicotine and Ischaemic Heart Disease
» Cognitive Impairment Central Nervous System
» Influence on Cognitive Performance
» Intellectual Impairment in Childhood
» Smoker Personality Profiles and Genetic Inheritance of Smoking
» Peculiarities of the Smoker’s Personality
» Reasons for Increased Cigarette Consumption
» Comorbidity Between Depression and Smoking
» Extent of Cigarette Consumption
» Effects of Smoking in Forms of Dementia
» Smoking and Parkinson’s Disease
» Diabetic Retinopathy Ocular Diseases
» Graves’ Ophthalmopathy Ocular Diseases
» Macular Degeneration Ocular Diseases
» Ocular Tumours Ocular Diseases
» Retinal Detachment Ocular Diseases
» Lipid and Cholesterol Metabolism
» Insulin Resistance Diabetic Nephropathy
» Oesophageal Cancer Gastrointestinal Tract
» Gastrointestinal Ulcers Gastrointestinal Tract
» Cancers of the Gastrointestinal Tract
» Pancreatic Cancer Gastrointestinal Tract
» Toxic Substances and Inducers
» Kidney Cancer Urinary Tract Diseases
» Bladder Cancer Urinary Tract Diseases
» Prostatic Hyperplasia and Prostatic Cancer
» Fertility Disorders Urinary Tract Diseases
» Vitamin D and Oestrogen Metabolism
» Osteoporosis Disorders of Mineral Metabolism and Bone
» Hip Fractures Disorders of Mineral Metabolism and Bone
» Skin Changes Skin and Mucosa
» Skin Tumours Skin and Mucosa
» Breast Cancer Skin and Mucosa
» Effects of Smoking on the Placenta
» Malformations Possibly Caused by Smoking
» Smoking and Sudden Infant Death Syndrome SIDS
» Effects of Nicotine on the Foetus
» Medical Care Costs Attributable to Smoking During Pregnancy
» ETS in the Workplace and at Home
» Fibrinogen Cholesterol Endothelium and Platelets
» Markers of Inflammation Changes at the Molecular and Cellular Level
» Passive Smoking During and After Pregnancy
» Coronary Heart Disease Cardiovascular Disease
» Stroke and Subarachnoid Haemorrhage
» Respiratory Tract in Children and Teenagers
» Bronchial Carcinoma Respiratory Tract
» Indications and Diagnostic Considerations
» Self-Help Interventions by the Smoker
» Physician Advice for Smoking Cessation
» Group Behaviour Therapy Programmes
» Mass Media Communication Strategies
» E-Learning, Email and Internet for Smoking Cessation
» Evaluation of Nicotine Products
» Nicotine Chewing Gum Nicotine
» Nicotine Sublingual Tablet Nicotine Nasal Spray
» Treatment and Dosage Nicotine
» Nicotine Chewing Gum Adverse Events Associated with NRT
» Nicotine Patch Adverse Events Associated with NRT
» Nicotine Nasal Spray Adverse Events Associated with NRT
» Nicotine Inhaler Adverse Events Associated with NRT
» Nicotine Sublingual Tablet Adverse Events Associated with NRT
» Nicotine Lozenge Adverse Events Associated with NRT
» Drug Interactions During Smoking Cessation
» Contraindications for the Use of Nicotine Products
» Nicotine Formulations as OTC Products
» Contraindications and Drug Interactions
» Tranquillisers and Buspirone Other Pharmacotherapies
» Various Antidepressants Other Pharmacotherapies
» Opioid Antagonists Other Pharmacotherapies
» Silver Acetate Other Pharmacotherapies
» Therapeutic Monitoring in Smoking Cessation
» Ischaemic Heart Disease Special Therapeutic Situations
» Pregnancy Special Therapeutic Situations
» Weight Gain Special Therapeutic Situations
» Alcohol Consumption Special Therapeutic Situations
» Organic Depression Organic Depression and Schizophrenia
» Schizophrenic Patients Organic Depression and Schizophrenia
» Interactions Between Cigarette Smoking and Administration of Psychopharmaceuticals
» Pre-operative Smoking Cessation Special Therapeutic Situations
» Social Influence Inoculation Strategy
» Life Skills Strategy Prevention Programmes for Schools
» Class 2000 Health Promotion Programme
» Trier University Health Programme Long-Term Studies
» Role of Teachers in Primary Prevention
» Prevention by Restricting Sales of Tobacco Products to Minors
» Role of the Mass Media in Sales of Tobacco Products to Adolescents
» Role of Government and Community in Primary Prevention
» Effect of Tobacco Industry Advertising Messages
» Tobacco Advertising and Adolescent Smoking Initiation
» Advertising with “Light” Cigarettes
» Smoking Bans in Public Buildings and Public Spaces
» Tobacco Industry, Governmental and Non-governmental Organisations
» Politicians and Their Attitude to Smoking
» Scientists and the Tobacco Industry
» Governmental Control of Toxic Tobacco Constituents
» Bans on Advertising in Various Countries
» Tobacco Industry: Playing Down the Risks of Smoking and Passive Smoking
» Smoking and Non-smoking: Weighing the Benefits
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