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Treating Tobacco Dependence Revised 2
- 1. Treating Tobacco Dependence Stacy Seikel, MD Board Certified Addiction Medicine Board Certified Anesthesiology
- 6. Cigarette smoking is the chief avoidable cause of death in our society
- 9. Cigarette Smoking is NOT a Habit
- 10. What Is Tobacco Dependence? It Is a CHRONIC MEDICAL DISEASE.
- 41. Orbach et al (2006) Drug Metabolism and Distribution http://dmd.aspetjournals.org/cgi/content/abstract/34/1/121 T ½ excretion = 17 ± 3 hours
- 43. Foulds (2006) J Clin Pract 60: 571–576
- 44. N N = Nicotine
- 45. N
- 46. N Na+
- 47. N V V = Varenicline N = Nicotine
- 48. N V V = Varenicline N = Nicotine
- 49. N V
- 50. N V
- 51. N V
- 52. N V
- 53. N V
- 54. N V
- 55. N V Na+
- 59. Varenicline-adverse effects Gonzales. JAMA 296:47-55 Nausea Dreams Insomnia Varenicline 28% 10% 14% Bupropion 12.5% 5.5% 22% Placebo 8.4% 5.5% 12.8%
- 60. Varenicline-study drug discontinuation due to adverse effects Gonzales. JAMA 296:47-55 Nausea All causes Varenicline 2.6% 8.6% Bupropion 1.8% 15.2% Placebo 0.3% 9.0%
- 62. Varenicline-discontinuation due to adverse effects, 1 year Williams. 23:793-801 Varenicline Placebo Adverse effects 26% 10% Lack of efficacy 0 5% Protocol deviations 2% 3% Lost to f/u 10% 15% Refusal to continue study 5% 16% All causes 46% 53%
- 63. Varenicline-adverse effects Williams. 23:793-801 Varenicline Placebo Nausea 40% 8% Dreams 23% 7% Insomnia 19% 9.5% Disgeusia 11% 2% Dizziness 8% 5% Any adverse effect 96% 83%
- 64. Varenicline-cessation Williams. 23:793-801 Varenicline Placebo Abstinence at week 52 37% 8%
- 71. Thank you.