COMPARATIVE EFFICACY AND TOLERABILITY OF NICOTINE REPLACEMENT THERAPIES

While tobacco use has declined in many industrialised nations, it rema ins a leading cause of preventable illness and death worldwide. Nicoti ne replacement therapy can play a role in assisting tobacco users to t erminate their addiction. To this end, 4 different nicotine replacemen t therapies have been developed: (i) nicotine chewing gum (polacrilex) ; (ii) transdermal nicotine systems (patch); (iii) nicotine nasal spra y; and (iv) nicotine inhalers. The efficacies of these therapies have been evaluated in terms of their ability to aid smoking cessation effo rts and to minimise aversive withdrawal symptoms. Tolerability has bee n evaluated in terms of adverse effect profiles and abuse liability. W hile more research evaluating the nasal spray and inhalers is needed, transdermal nicotine appears to offer the best combination of efficacy , withdrawal suppression, adverse effects and abuse liability. It has proven efficacy when used in combination with different levels of beha vioural therapy. Directions for future research include combination th erapies, the most appropriate concentration of nicotine and treatment individualisation.