Drug treatment of hypertension

Smoking cessation pharmacotherapy

Cigarette smoking remains an important risk factor for premature cardiovascular disease and its many complications. There are clear benefits from treating tobacco dependence on the rate of clinical outcomes. In addition to behavioral therapies, various pharmacologic strategies have been developed to help achieve this goal. First-line therapies include nicotine replacement, bupropion and varenicline, a partial nicotine antagonist. Second-line treatments include clonidine and nortriptyline. Additional treatment strategies with less proven efficacy include monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, opioid receptor antagonists, bromocriptine, anti-anxiety drugs, nicotinic receptor antagonists (e.g. mecamylamine) and glucose tablets. Various approaches under investigation include inhibitors of the hepatic P450 enzyme (e.g. methoxsalen), cannabinoid-1 receptor antagonists (e.g. rimonabant), and nicotine vaccines.

Smoking Cessation Pharmacotherapy?Nicotine and Non-Nicotine Preparations

Cigarette smokers tend to die prematurely from a number of diseases. Cigarette smoking is an important modifiable risk factor for cardiovascular morbidity and mortality. Despite the clear health benefits of smoking cessation, smokers usually find it difficult to stop and behavioral therapies often prove insufficient. Pharmacologic intervention may aid the process because of the addictive nature of nicotine. Nicotine replacement therapy, which is regarded as first-line therapy, was developed to overcome the symptoms of nicotine withdrawal that many patients find distressing. Different modes of administration include inhalation and buccal or transdermal absorption. The orally administered non-nicotine drugs varenicline and bupropion are also regarded as first-line treatments, either used alone or as an adjunct to nicotine replacement therapy. Second-line treatments include clonidine and nortriptyline. Other treatment strategies that have been examined include monoamine oxidase inhibitors and selective serotonin reuptake inhibitors; efficacy has yet to be proven definitively. A novel approach to treatment using the cannabinoid-1 receptor antagonist rimonabant is also under investigation.