Monday, January 12, 2015

Rate of Nicotine Metabolism May Predict Best Way to Quit Smoking

How quickly a smoker metabolizes nicotine could determine which type of cessation strategy has the best chance of success, according to a new study that represents one of the largest pharmacogenetic analyses of tobacco dependence to date.

The study found that smokers with normal metabolism levels had better quit rates with varenicline therapy, which does not involve nicotine replacement, compared to a nicotine patch. For people with slow nicotine metabolism, the patch may be the better option.

It has been known for a while that smokers clear nicotine from their bodies at different rates, but until now it wasn’t known if this measurable trait--the nicotine metabolite ratio (NMR)--could be used to optimize treatment and improve outcomes.

The study researchers randomly assigned 1,246 smokers (662 slow metabolizers and 584 normal metabolizers) to 11 weeks of the nicotine patch and placebo pill, varenicline and placebo patch, or double placebo; all participants also received behavioral counselling.

After 11 weeks of treatment, normal metabolizers taking varenicline were about twice as likely not to smoke as those using the nicotine patch. And while slow metabolizers displayed similar effectiveness rates on varencline or the patch, they reported far fewer side effects for patch therapy.

To read more about how smoking cessation leads to improved mental health, see the Psychiatric News article "Smoking Cessation Bestows Multiple Mental Health Benefits." Also, to learn about a potential new adaptive cessation strategy, see the American Journal of Psychiatry study "Combination Treatment With Varenicline and Bupropion in an Adaptive Smoking Cessation Paradigm."



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