Tan Linxiang, Tang Quansheng, Hao Wei
Mental Health Institute, Central South University, WHO Collaborating Center for Drug Abuse and Health, Changsha 410011, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009 Nov;34(11):1049-57.
Tobacco use is the single most preventable cause of death, disability and disease in the world and is projected to be the leading cause of death and disability across all developed and developing countries by 2020. Nicotine, the primary active ingredient of cigarettes that contributes to physical dependence, acts on nicotine receptors in the central nervous system and leads to the release of neurotransmitters (such as dopamine). Like other drugs of abuse, nicotine is thought to produce reinforcing effect by activating the mesocorticolimbic dopamine system. A wide variety of cessation treatments of nicotine dependence is commercially available, yet only 2 general approaches have received empirical validation: behavioral intervention (including 5 As brief intervention) and pharmacotherapy. The evidences show that 5 As brief intervention is one of the most cost-effective treatments in clinical work for busy physicians. Three types of medications have been available in market for smoking cessation treatment: nicotine replacement treatment (NRT, i.e., transdermal patch, gum, inhaler, nasal spray, and lozenge), sustained release bupropion and varenicline. Varenicline, a novel alpha4beta2 nicotinic receptor partial agonist, is effective for tobacco dependence. Phase III trials suggest that it is more effective than NRT and bupropion SR. The safety profile of varenicline is excellent, with the most commonly occurring adverse events, nausea, typically mild and well tolerated. However, new safety warnings are added to the varenicline label because of post-marketing report including agitation, depression and suicidality. A causal connection between varenicline use and these symptoms has not been established.
烟草使用是世界上唯一最可预防的死亡、残疾和疾病原因，预计到2020年将成为所有发达国家和发展中国家死亡和残疾的主要原因。尼古丁是香烟的主要活性成分，会导致身体依赖，作用于中枢神经系统中的尼古丁受体，并导致神经递质（如多巴胺）的释放。与其他滥用药物一样，尼古丁被认为通过激活中脑边缘多巴胺系统产生强化作用。目前市面上有各种各样的尼古丁依赖戒烟治疗方法，但只有两种通用方法得到了实证验证：行为干预（包括5A简短干预）和药物治疗。证据表明，5A简短干预是忙碌医生临床工作中最具成本效益的治疗方法之一。市面上有三种药物可用于戒烟治疗：尼古丁替代疗法（NRT，即透皮贴剂、口香糖、吸入器、鼻喷雾剂和含片）、缓释安非他酮和伐尼克兰。伐尼克兰是一种新型的α4β2烟碱受体部分激动剂，对烟草依赖有效。III期试验表明，它比NRT和缓释安非他酮更有效。伐尼克兰的安全性极佳，最常见的不良事件是恶心，通常症状较轻且耐受性良好。然而，由于上市后报告包括激动、抑郁和自杀倾向，伐尼克兰标签上增加了新的安全警告。尚未确定使用伐尼克兰与这些症状之间存在因果关系。
