In the first study to adjust nicotine dosing based on the choice of smokers while trying to give up, results show that most smokers who use smoking drugs can easily tolerate doses that are four times higher than those that are usually recommended.
The author of the study, Dunja Przulj, from the Wolfson Institute of Preventive Medicine, says: "Smokers determine their nicotine intake while smoking, but when trying to give up their nicotine levels are dictated by the recommended dosage of treatment. may be too low for some people, increasing the likelihood that they will return to smoking.
"Nicotine's nicotine products can be smokers with less dosing and could explain why we saw limited success in treatments, such as patches and chewing gums, helping smokers to give up. Now a shift in their application is needed.
"Our findings should ensure safety for smokers that it is okay to use any nicotine doses that will help them."
First study to explore a new way of nicotine dosing
When nicotine replacement therapy was first evaluated in the 1970s, low doses were used due to concerns about toxicity and dependence. Evidence has been proven that nicotine alone, outside tobacco products, has limited dependence and that higher doses are safe and well-tolerated. Despite this, anti-smoking drugs kept lower levels of nicotine in their products.
A new study published in the journal Addiction, has examined 50 smokers in the Argentina Tobacco Dependency Clinic and is the first to try a combined access to pre-loading nicotine prior to the release date and adjustment of nicotine levels based on patient feedback.
Participants started on a daily 21mg nicotine patch four weeks before their release date. The dose is increased once a week from another 21mg patch unless the participants report adverse effects or do not want to increase the dose to a maximum of four patches totaling 84mg / day. The dose was reduced by 21mg / day each week for one week after their release date, until it returned to the standard dose (21mg / day) four weeks later.
The participants were advised to continue to smoke as desired during the period before giving up and were offered additional therapies for nicotine replacement.
The team found that:
- Of the 50 participants, 90 per cent progressed to at least three patches, while 72 per cent progressed to four patches.
- 82 per cent of participants achieved four-week-old smoking abstinence and did not experience a significant increase in withdrawal symptoms, including smoking preferences.
- Cigarette consumption, smoke intake and smoking enjoyment decreased considerably during the period before they were dropped, and the intervention was assessed as useful and easy to follow.
- During the pre-cancellation period, the number of cigarettes smoked daily significantly decreased from 20 per day to 6 days from the date of the cancellation.
- The number of adverse reactions has increased as the dose of the patch increased. The most common of them were nausea, followed by vomiting, but were generally mild and well tolerated.
- Two participants evaluated their adverse effects as "severe", and at a dose of 63 mg. One reported headaches, nausea and feeling of weakness; the other experienced nausea and blurred vision. Both reduced their dose to 42mg / day.
- Only 6% of participants went out of treatment and no one turned out because of the side effects of mushrooms.
The results could explain the popularity of e-cigarettes
Professor Peter Hike of Queen Marie Institute of Preventive Medicine added: "Smokers are perfectly able to determine which nicotine doses help. There is no risk of a dangerous overdose because nicotine involves an effective safety valve in the form of nausea.
"Our results also suggest that one of the reasons why e-cigarettes are much more popular and potentially more effective than other nicotine replacement treatments is that smokers can adjust their nicotine intake to their needs."
It is thought that "pre-loading" with nicotine leading up to the date of cancellation can help weaken the conditional relationship between behavior and smoking rewards, and reduce smoking enjoyment. Also, if the previous nicotine load is high enough, the extra nicotine intake of cigarettes should cause nausea and become aversive.
The next step is to carry out a larger randomized study to confirm that increased dosing, and especially its use before withdrawal, increases treatment efficacy.
The current study is limited in that it does not include placebo control, so abstinence data are only indicative. The indicated reduction in smoking enjoyment could also have an impact on expectations. Additionally, with a sample of 50, rare adverse reactions can not be ruled out.
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