MECAMYLAMINE COMBINED WITH NICOTINE SKIN PATCH FACILITATES SMOKING CESSATION BEYOND NICOTINE PATCH TREATMENT ALONE

Objective: To evaluate concurrent administration of mecamylamine (nico tine antagonist) with nicotine skin patch treatment for smoking cessat ion. Methods: This was a randomized, double-blind, placebo-controlled trial. Forty-eight healthy smokers who smoked at least one pack per da y were studied at an outpatient smoking cessation research clinic. The subjects ranged in age from 20 to 40 years. Intervention with the nic otine skin patch (6 to 8 weeks) plus oral mecamylamine (2.5 to 5 mg tw ice a day for 5 weeks) was compared to nicotine patch plus placebo. Me camylamine treatment began 2 weeks before smoking cessation. The prima ry outcome was continuous abstinence through 7 weeks after cessation ( I week after treatment), confirmed by expired air carbon monoxide meas urements. Secondary measures included point abstinence at 7 weeks, con tinuous abstinence at 6- and 12-month follow-up, and self-reported wit hdrawal symptoms. Results: The continuous abstinence rate at 7 weeks w as three times higher in the mecamylamine condition: 50% versus 16.7%, p = 0.015. Point abstinence at 7 weeks was 58% for mecamylamine versu s 29% for placebo, p = 0.044. At follow-up, continuous abstinence rema ined higher for mecamylamine: 37.5% versus 12.5% at 6 months (P = 0.04 6) and 37.5% versus 4.2% at 12 months (p = 0.004). Mecamylamine also s ignificantly reduced craving for cigarettes, negative affect, and appe tite. Conclusions: Agonist-antagonist therapy, consisting of the nicot ine patch with oral mecamylamine, may substantially improve current sm oking cessation treatment.