Novel Delivery Systems for Nicotine Replacement Therapy as an Aid to Smoking Cessation and for Harm Reduction: Rationale, and Evidence for Advantages over Existing Systems

@article{Shahab2013NovelDS,
  title={Novel Delivery Systems for Nicotine Replacement Therapy as an Aid to Smoking Cessation and for Harm Reduction: Rationale, and Evidence for Advantages over Existing Systems},
  author={Lion Shahab and Leonie S. Brose and Robert J West},
  journal={CNS Drugs},
  year={2013},
  volume={27},
  pages={1007-1019}
}
Nicotine replacement therapy (NRT) has been used in the treatment of tobacco dependence for over three decades. Whilst the choice of NRT was limited early on, in the last ten years there has been substantial increase in the number of nicotine delivery devices that have become available. This article briefly summarises existing forms of NRT, evidence of their efficacy and use, and reviews the rationale for the development of novel products delivering nicotine via buccal, transdermal or pulmonary… 
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34 Citations
Background Citations
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34 Citations

Evaluation of Nicotine Pharmacokinetics and Subjective Effects following Use of a Novel Nicotine Delivery System
TLDR
P3L is an innovative nicotine delivery product that will be acceptable to adult smokers as an alternative to cigarettes and shows potential over existing nicotine delivery systems by delivering nicotine with kinetics close to published data on conventional cigarettes and without exogenous carrier substances.
Pharmacological therapies in smoking cessation: an evidence-based update
TLDR
Recent updates to the literature regarding nicotine replacement, bupropion, and varenicline are reviewed; re-emerging therapies such as cytisine are reviewed, as well as the novel concept of vaccination.
New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?
TLDR
This paper compares the first-line smoking cessation medications with 24 alternative products, and cytisine looks most promising in having established efficacy and safety with low cost.
Electronic cigarettes are at least as effective as nicotine patches for smoking cessation
TLDR
E-cigarettes have been shown to reduce craving and withdrawal symptoms in abstinent smokers and, as nicotine is delivered without tobacco combustion, are thought to be substantially safer than cigarettes.
Current and Emerging Pharmacotherapies for Cessation of Tobacco Smoking
TLDR
This article reviewed existing and emerging smoking cessation pharmacotherapies, with a special emphasis on the most promising agents that are currently being investigated, including NRT, bupropion, and varenicline.
Review: Pharmacotherapy for smoking cessation
TLDR
The use of NRT (nicotine patch + nicotine gum/lozenge/inhaler/spray), bupropion (with NRT), or varenicline is strongly recommended for smoking cessation, unlessthey are contraindicated.
Deregulation of Nicotine Replacement Therapy Products in Finland : Reasons for Pharmaceutical Policy Changes and Reflections on Smoking Cessation Practices
TLDR
The analysis revealed that two of the most important motives for the deregulation, poor NRT availability and NRT’s effectiveness in SC, were largely based on assumptions instead of actual scientific evidence.
Prevalence of NRT Use and Associated Nicotine Intake in Smokers, Recent Ex-Smokers and Longer-Term Ex-Smokers
TLDR
Conurrent use of nicotine replacement therapy while smoking is relatively uncommon and is not associated with higher levels of nicotine intake, but among ex-smokers, NRT use is common in the short but not longer-term and among longer- term users is associated with lower nicotine intake than in smokers.
Prevalence and impact of long-term use of nicotine replacement therapy in UK stop-smoking services: findings from the ELONS study. Nicotine and
TLDR
This study shows that in the context of SSS, clients rarely use products for up to a year and that NRT use does not affect users’ stress response, and appears to be a safe and effective way to reduce exposure to combustible nicotine.
Prevalence and Impact of Long-term Use of Nicotine Replacement Therapy in UK Stop-Smoking Services: Findings From the ELONS Study
TLDR
This study shows that in the context of SSS, clients rarely use products for up to a year and that NRT use does not affect users’ stress response, and long-term NRT appears to be a safe and effective way to reduce exposure to combustible nicotine.
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References

SHOWING 1-10 OF 123 REFERENCES
Nicotine delivery systems
TLDR
There is clearly much to be done to improve the proportion of quitters who use evidence-based treatment, their use of the products, and the usability and inherent efficacy of NRT.
Nicotine replacement therapy for smoking cessation.
TLDR
The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the smoker, and the combination of bupropion and nicotine patch was significantly more effective than nicotine patch alone.
Nicotine replacement therapy in smoking cessation.
Evidence for benefit from nicotine replacement therapy in hospital patients is inconclusive, although the results of a trial reported in this issue of Thorax give cause for optimism and should…
Acceptability and effectiveness for withdrawal symptom relief of a novel oral nicotine delivery device: a randomised crossover trial
TLDR
The ‘Nicotine Cannon’ is at least as effective as equivalent NRT in reducing withdrawal symptoms and more acceptable to users, suggesting that it would be a useful addition to existing NRT.
A systematic review of nicotine by inhalation: is there a role for the inhaled route?
  • B. Caldwell, W. Sumner, J. Crane
  • Medicine, Biology
    Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
  • 2012
TLDR
Pulmonary nicotine delivery might be maximized by use of nicotine salts, which have a more physiological pH than pure nicotine, by ensuring the mass of the particles is optimal for alveolar absorption, and by adding flavoring agents.
Policy recommendations for smoking cessation and treatment of tobacco dependence
  • T. Lam
  • Medicine, Psychology
  • 2003
A review of the evidence base of effective smoking cessation and treatment of tobacco dependence demonstrates that behavioural and pharmacological therapies for tobacco dependence can contribute…
Developments in pharmacotherapy for tobacco dependence: past, present and future.
TLDR
There is a need for studies designed to evaluate the efficacy of pharmacotherapies in populations such as youth, pregnant smokers and smokers with co-occurring mental health problems, and for long-term combination pharmacotherapy combined with improved psychosocial support to enhance medication compliance.
Novel Pharmacological Approaches for Treating Tobacco Dependence and Withdrawal
TLDR
A range of novel pharmacological approaches for the treatment of tobacco dependence and/or withdrawal are focused on, including oral and pulmonary nicotine delivery and the following non-nicotinic medications: antidepressants, an α4β2 nicotine partial agonist, anα2-noradrenergic agonists, cytochrome P450 (CYP) 2A6 inhibitors, opioid antagonists and GABAergic medications.
Improved treatment of nicotine addiction and emerging pulmonary drug delivery.
TLDR
This review will discuss some novel strategies and future directions for pulmonary drug delivery, an emerging route of administration for smoking cessation, and the advancement of knowledge on pulmonary drug Delivery will provide better management for nicotine addiction and other addictive disorders.
Randomised controlled trial of nasal nicotine spray in smoking cessation
...
...