NICOTINE MECAMYLAMINE COMBINATION TREATMENT FOR SMOKING CESSATION/

Pharmacotherapies for smoking cessation that can be used in a minimal behavioral intervention setting are urgently needed. The studies descr ibed in this article show that the nicotinic antagonist mecamylamine i s efficacious when administered in combination with nicotine replaceme nt. Mecamylamine and nicotine have been shown to act in concert to att enuate the rewarding effects of cigarette smoking, reduce craving, and suppress ad lib smoking. Moreover, long-term abstinence rates followi ng nicotine/mecamylamine treatment are roughly two to three times high er than with standard nicotine replacement therapy using nicotine skin patches. In one study, the initiation of mecamylamine treatment prior to the target quit-smoking date was shown to be critical in promoting subsequent continuous abstinence from smoking. The main interpretatio n of this finding is that smoking in the presence of blockade of rewar d promotes extinction of smoking behavior, raising the likelihood of s uccessful smoking cessation. Directions for future research are also d iscussed, including mechanistic studies of nicotinic receptor subtypes affected by nicotine and mecamylamine, as well as assessment of the o ptimal timing, doses, and route of administration of the two drugs in smoking cessation treatment. Overall, the results show that two classi c approaches to the treatment of drug dependence, substitution, and bl ockade, are not mutually exclusive and in fact can be combined fruitfu lly in the treatment of nicotine addiction. (C) 1996 Wiley-Liss, Inc.