N-n-alkylnicotinium analogs, a novel class of nicotinic receptor antagonist: inhibition of S(-)-nicotine-evoked [(3)H]dopamine overflow from superfused rat striatal slices

The structure of the S(-)-nicotine molecule was modified via N-n-alkylation of the pyridine-N atom to afford a series of N-n-alkylnicotinium iodide salts with carbon chain lengths varying between C(1) and C(12). The ability of these analogs to evoke [(3)H] overflow and inhibit S(-)-nicotine-evoked [(3)H] overflow from [(3)H]dopamine ([(3)H]DA)-preloaded rat striatal slices was determined. At high concentrations, analogs with chain lengths > or =C(6) evoked [(3)H] overflow. Specifically, N-n-decylnicotinium iodide (NDNI; C(10)) evoked significant [(3)H] overflow at 1 microM, and N-n-dodecylnicotinium iodide (NDDNI; C(12)) at 10 microM, whereas N-n-octylnicotinium iodide (NONI; C(8)), N-n-heptylnicotinium iodide (NHpNI; C(7)), and N-n-hexylnicotinium iodide (C(6)) evoked [(3)H] overflow at 100 microM. Thus, intrinsic activity at these concentrations prohibited assessment of inhibitory activity. The most potent N-n-alkylnicotinium analog to inhibit S(-)-nicotine-evoked [(3)H] overflow was NDDNI, with an IC(50) value of 9 nM. NHpNI, NONI, and N-n-nonylnicotinium iodide (C(9)) also inhibited S(-)-nicotine-evoked [(3)H] overflow with IC(50) values of 0.80, 0.62, and 0.21 microM, respectively. In comparison, the competitive neuronal nicotinic acetylcholine receptor (nAChR) antagonist, dihydro-beta-erythroidine, had an IC(50) of 1.6 microM. A significant correlation of N-n-alkyl chain length with analog-induced inhibition was observed, with the exception of NDNI, which was devoid of inhibitory activity. The mechanism of N-n-alkylnicotinium-induced inhibition of the high-affinity, low-capacity component of S(-)-nicotine-evoked [(3)H] overflow was determined via Schild analysis, using the representative analog, NONI. Linear Schild regression and slope not different from unity suggested that NONI competitively interacts with a single nAChR subtype to inhibit S(-)-nicotine-evoked [(3)H]DA release (K(i) value = 80.2 nM). Thus, modification of the S(-)-nicotine molecule converts this agonist into an antagonist at nAChRs, mediating S(-)-nicotine-evoked DA release in striatum.

Synthesis and pharmacological evaluation of some (pyridyl)cyclopropylmethyl amines and their methiodides as nicotinic receptor ligands

A series of 3- and (4-pyridyl)cyclopropylmethyl amines and their quaternary ammonium derivatives have been synthesized; they can be considered as rigid analogues of nicotine. The compounds have been tested on rat cerebral cortex to measure the affinity for the central nicotinic receptor. Only the methiodides show affinity in the micromolar range. The results obtained can provide useful information on the topography of the nicotinic receptor-binding site.

Enhanced inhibition of a mutant neuronal nicotinic acetylcholine receptor by agonists: protection of function by (E)-N-methyl-4-(3-pyridinyl)-3-butene-1-amine (TC-2403)

Inhibition of neuronal nicotinic receptors can be regulated by sequence in the beta subunit second transmembrane domain (TM2). The incorporation of a beta4(6'F10'T) subunit, which contains sequence from the muscle beta subunit at the TM2 6' and 10' positions of the neuronal beta4 subunit, increases the loss of receptor responsiveness after the application of acetylcholine (ACh), nicotine, or 3-(2,4-dimethoxybenzylidene)-anabaseine (DMXB), an alpha7-selective partial agonist. Inhibition of receptor responsiveness following agonist exposure may occur through either an enhancement of desensitization, increased channel block by an agonist, or alternatively via allosteric modulation. Although DMXB produces very little activation of either alpha3beta4 or alpha3beta4(6'F10'T) receptors, DMXB shows an enhanced use-and voltage-dependent inhibition of alpha3beta4(6'F10'T) receptors compared with wild-type. In contrast, the alpha4beta2-selective agonist (E)-N-methyl-4-(3-pyridinyl)-3-butene-1-amine (TC-2403, previously identified as RJR-2403) shows increased activation of alpha3beta4(6'F10'T) receptors compared with alpha3beta4 receptors (as related to ACh activation) but with no significant increase in antagonist activity. The interaction between the binding of local anesthetics and the functional inhibition produced by these agonists was evaluated. The binding of the local anesthetics to their inhibitory sites does not affect inhibitory effects of DMXB and nicotine. However, TC-2403 can protect receptor function from the inhibitory effects of other agonists, suggesting that TC-2403, as well as agonists that cause inhibition, may be binding to an allosteric site, either promoting or inhibiting channel opening. The ability of TC-2403 to protect receptor function from agonist-induced inhibition may point toward valuable new combination drug therapies.

Development and evaluation of a biphasic buccal adhesive tablet for nicotine replacement therapy

Bilayer nicotine mucoadhesive tablets were prepared and evaluated to determine the suitability of the formulation as a nicotine replacement product to aid in smoking cessation. A range of formulations containing 0-50% w/w Carbopol 934 and 0-50% w/w hydroxypropylcellulose (HPC) were prepared and tested for adhesive properties and drug release. Mucoadhesion was assessed using bovine buccal mucosa. Peak detachment force of the tablets was found to reach a maximum at 20% w/w Carbopol 934, whilst work of adhesion continued to increase with Carbopol 934 concentration. HPC concentrations of 20-30% w/w were found to provide nicotine hydrogen tartrate (NHT) release approaching zero order kinetics over a 4 h test period. A combination of 20% w/w Carbopol 934 and 20% w/w HPC was thus found to provide suitable adhesion and controlled drug release. The formulation of a bilayer tablet containing the adhesive controlled release layer (CRL) and a fast releasing layer provided an initial burst release of NHT followed by the controlled release for a period of up to 4 h. The same biphasic type of release was identified during an in vivo assessment using human volunteers This biphasic drug release could represent an improvement over current methods of nicotine replacement.

Aqueous aldol catalysis by a nicotine metabolite

Nornicotine, an endogenous tobacco alkaloid and minor nicotine metabolite, can catalyze aldol reactions at physiological pH. Catalysis appears to be due to a covalent enamine mechanism, an unprecedented reaction with small organic molecule catalysts in aqueous buffer. Kinetic parameters for nornicotine as well as other related alkaloids were measured and demonstrate that both the pyrrolidine and pyridine rings are critical for optimal catalysis. Substrate compatibility of this catalyst and its implications in vivo are discussed.

[Results of clinical use of nicotine chewing gum "Nicorette" in the practice of treating patients with psychological and behavior disorders caused by tobacco consumption]

Expediency is substantiated of a wide use of nicotine-containing chewing-gum "Nicorette" as treatment of nicotine dependence. The study comprising 47 patients has shown the drug monotherapy to yield a positive result in 76.6 percent of cases. The conclusion reached is that the nicotine-containing chewing-gum "Nicorette" is a highly effective and safe medication that can come to be widely used for treating those patients who are prolonged and continuous users of tobacco and for preventing recurrences of nicotine dependence.

[Nicotine substitution therapy: 10 years later]

To be efficient, nicotine substitution therapy (NST) must be part of a global strategy comprising several stages. The first consists in evaluating and re-enforcing motivation, since smoking cessation is impossible unless the patient is clearly motivated. The second stage is the withdrawal period that lasts for several days or months. NST is the first medicinal treatment that has demonstrated its efficacy in controlled studies: it reduces the withdrawal syndrome and doubles the chances of success at the end of the standard 3-month treatment. Recent studies have shown that the results can be improved: by adapting the dose to the degree of dependency and by using higher doses and/or associating two types of nicotine substitutes; by prolonging NST for as long as the withdrawal syndrome persists; by treating the anxiety and depression, often present in heavy smokers. The third stage is aimed at avoiding relapses, by ensuring prolonged follow-up and treating the various possible causes: eating disorders and weight gain, acute or chronic stress, depression, environment.... At all the stages of care, behavioural and cognitive therapy enhances the chances of success.

Functional diversity among 5-substituted nicotine analogs; in vitro and in vivo investigations

Two 5-substituted derivatives of nicotine (nicotinic acetylcholine receptor: K(i)=2.4 nM) were synthesized and evaluated: 5-bromonicotine (K(i)=6.9 nM) and 5-methoxynicotine (K(i)=14.3 nM). Despite their high affinity, neither 5-bromonicotine nor 5-methoxynicotine mimicked nicotine in producing antinociceptive (tail-flick, hotplate), hypolocomotor, or hypothermic effects in mice. Neither agent antagonized the hypolocomotor actions of nicotine, whereas 5-methoxynicotine, but not 5-bromonicotine, antagonized the antinociceptive (tail-flick) activity of nicotine in a dose-related manner. In tests of stimulus generalization using rats trained to discriminate 0.6 mg/kg of (-)-nicotine from vehicle, 5-bromonicotine substituted for nicotine. Further evaluation of 5-bromonicotine indicated that it might be a partial agonist at alpha4beta2 receptors (stimulation of Rb(+) efflux; alpha4beta2 receptors expressed in oocytes) and at alpha3-containing nicotinic acetylcholine receptors (synaptosomal dopamine release). Thus, 5-bromonicotine might be acting as a partial agonist at alpha4beta2 receptors and/or some of its effects might be related to interactions with non-alpha4beta2 receptors. Clearly, the effects of 5-bromonicotine and 5-methoxynicotine are different from those of nicotine, and from one another. These actions demonstrate that substitution at the 5-position of nicotine exerts a profound influence on the pharmacological profile as well as agonist/antagonist properties of nicotine.

Self-help interventions for smoking cessation

BACKGROUND

Many smokers give up smoking on their own, but materials giving advice and information may help them and increase the number who quit successfully.

OBJECTIVES

The aims of this review were to determine the effectiveness of different forms of self-help materials, compared with no treatment and with other minimal contact strategies; the effectiveness of adjuncts to self-help, such as computer generated feedback, telephone hotlines and pharmacotherapy; and the effectiveness of approaches tailored to the individual compared with non-tailored materials.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group trials register using the terms 'self-help', 'manual*' or 'booklet*'. Date of the most recent search March 2002.

SELECTION CRITERIA

We included randomised trials of smoking cessation with follow-up of at least six months, where at least one arm tested a self-help intervention. We defined self-help as structured programming for smokers trying to quit without intensive contact with a therapist.

DATA COLLECTION AND ANALYSIS

We extracted data in duplicate on the type of subjects, the nature of the self-help materials, the amount of face to face contact given to subjects and to controls, outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates when available. Where appropriate, we performed meta-analysis using a fixed effects model.

MAIN RESULTS

We identified fifty-one trials. Thirty two compared self-help materials to no intervention or tested materials used in addition to advice. In eleven trials in which self-help was compared to no intervention there was a pooled effect that just reached statistical significance (odds ratio 1.24, 95% confidence interval 1.07 to 1.45) This analysis excluded one trial with a strongly positive outcome that introduced significant heterogeneity. Four further trials in which the control group received alternative written materials did not show evidence for an effect of the smoking self-help materials. We failed to find evidence of benefit from adding self-help materials to face to face advice, or to nicotine replacement therapy. There was evidence from fourteen trials using materials tailored for the characteristics of individual smokers that such personalised materials were more effective than standard manuals (ten trials, odds ratio 1.36, 95% confidence interval 1.13 to 1.64) or no materials (three trials, odds ratio 1.80, 95% confidence interval 1.46 to 2.23). A small numbers of trials failed to detect benefit from using additional materials or targetted materials.

REVIEWER'S CONCLUSIONS

Standard self-help materials may increase quit rates compared to no intervention, but the effect is likely to be small. We failed to find evidence that they have an additional benefit when used alongside other interventions such as advice from a health care professional, or nicotine replacement therapy. There is evidence that materials that are tailored for individual smokers are more effective.

Contributory role for nornicotine in nicotine neuropharmacology: nornicotine-evoked [3H]dopamine overflow from rat nucleus accumbens slices

Nornicotine is a tobacco alkaloid and an active nicotine metabolite, which accumulates in brain to pharmacologically relevant concentrations following repeated nicotine administration to rats. Furthermore, nornicotine is self-administered by rats, indicating that it has reinforcing efficacy and may contribute to nicotine dependence. Since drugs of abuse activate the mesolimbic dopamine (DA) system to produce rewarding effects, the present study tested the hypothesis that nornicotine evokes DA release from nucleus accumbens in a nicotinic receptor-mediated manner. Rat nucleus accumbens slices were preloaded with [3H]DA and superfused for 60 min in the absence and presence of a range of alkaloid concentrations. Superfusate samples were collected and alkaloid-evoked [3H]overflow was determined. S(-)-Nornicotine (EC(50) value = 3.0 microM), R(+)-nornicotine (EC(50) value = 0.48 microM), and S(-)-nicotine (EC(50) value = 70 nM) evoked [3H]overflow in a concentration-dependent manner. For each nornicotine enantiomer, 0.3 microM was the lowest concentration to evoke significant [3H]overflow. Dihydro-beta-erythroidine (DHbetaE, 10 microM), a classical nicotinic receptor antagonist, inhibited the S(-)-nornicotine-evoked [3H]overflow, indicating the involvement of nicotinic receptors. Furthermore, the effect of S(-)-nornicotine was calcium-dependent, consistent with a nicotinic receptor-mediated mechanism. Whereas S(-)-nornicotine was found previously to be more potent in the striatum, R(+)-nornicotine was more potent than its enantiomer in nucleus accumbens, suggesting the involvement of different nicotinic receptor subtypes in these brain regions. Thus, the results of the current study indicate that nornicotine stimulated DA release from nucleus accumbens in a nicotinic receptor-mediated manner, further supporting the hypothesis that nornicotine contributes to tobacco dependence.

Synthesis of (+/-)-methyl-(1-aryl-4-pyridin-3-yl-but-3-enyl)-amines

trans-Metanicotine, a subtype (alpha4beta2)-selective ligand for neuronal nicotinic acetylcholine receptor, is under clinical phase for Alzheimer's disease. An efficient synthetic route for (+/-)-methyl-(1-aryl-4-pyridin-3-yl-but-3-enyl)-amines, derivatives of trans-metanicotine, was explored. Allylation reaction of aryl aldimines with allylmagnesium bromide in THF gave (+/-)-methyl-(1-aryl-but-3-enyl)-amines. Protection of the amines with the Boc group and following Heck reaction of the N-Boc amines with 3-bromopyridine gave (+/-)-methyl-(1-aryl-4-pyridin-3-yl-but-3-enyl)-carbamic acid tert-butyl esters. Deprotection of the N-Boc group in aqueous 1N-HCI solution gave the titled amines in good yields. Thus, trans-metanicotine analogues modified at the a-position of the methylamino group with aryl groups were obtained in 5 steps.

Tobacco smoking, nicotine, and nicotine and non-nicotine replacement therapies

Tobacco smoking is associated with an increased risk for the development of coronary and pulmonary vascular diseases and smoking cessation will greatly reduce this risk. Nicotine replacement and nonnicotine modalities have been used alone and in combination to help in smoking cessation. These treatment modalities appear to be safe in patients with known stable coronary artery disease.

Enantiospecific synthesis of annulated nicotine analogues from D-glutamic acid. 7-Azabicyclo[2.2.1]heptano[2.3-c]pyridines

The conformationally restricted nicotinoid (1S,4S)-7-methyl-7-azabicyclo[2.2.1]heptano[2,3-c]pyridine dihydrochloride has been prepared enantiospecifically from D-glutamic acid. The method involved a lithium cis-2,6-dimethylpiperidide-mediated intramolecular anionic cyclization of (2S,5R)-N-(tert-butyloxycarbonyl)-5-[3-(4-N-chloropyridinyl]proline methyl ester in tandem with a standard decarboxylation sequence. Reductive amination afforded the desired N-methylated [2.2.1]bicyclonicotinoid. Cyclization of the corresponding iodopyridinylproline methyl ester, obtained via ultrasound-facilitated chloro-iodo exchange, was also effected.

Using nicotine replacement therapy in treating nicotine addiction in adolescents

Cigarette smoking is the greatest cause of preventable death and disability in the United States. More than 3,000 children in the United States begin smoking each day. Smokers experience withdrawal symptoms that can be ameliorated by pharmacological interventions. These interventions include Zyban (Bupropion HCl), Nicorette gum, Habitrol patch, Nicoderm patch, Nicotrol inhaler, and Nicotrol NS spray, along with their generic counterparts. This article reviews each of these agents, the time course of nicotine withdrawal symptoms, and the Fagerstrom Tolerance Questionnaire and presents a framework for assisting the nicotine-addicted student in smoking cessation.

Nornicotine, a nicotine metabolite and tobacco alkaloid: desensitization of nicotinic receptor-stimulated dopamine release from rat striatum

Nornicotine, a major tobacco alkaloid and nicotine metabolite, accumulates in rat brain in pharmacologically relevant concentrations following repeated nicotine administration. Nornicotine-evoked striatal dopamine release is Ca2+-dependent, stereoselective and sensitive to nicotinic receptor antagonists, indicating nicotinic receptor-mediation. The present study determined if S-(-)-nornicotine desensitizes nicotinic receptors and if cross-desensitization to S-(-)-nicotine occurs. S-(-)-Nicotine (10 and 100 nM) diminished [3H]overflow from [3H]dopamine-preloaded rat striatal slices following subsequent superfusion with 10 microM S-(-)-nicotine (46% and 74%, respectively) or 10 microM S-(-)-nornicotine (59% and 81%, respectively). S-(-)-Nornicotine (1 and 10 microM) diminished the response to subsequent superfusion with 10 microM S-(-)-nornicotine (85% and 97%, respectively) or 10 microM S-(-)-nicotine (82% and 88%, respectively). Thus, similar to S-(-)-nicotine, S-(-)-nornicotine desensitizes nicotinic receptors. but with approximately 12-fold lower potency. Cross-desensitization suggests involvement of common nicotinic receptor subtypes. Therefore, S-(-)-nicotine metabolites, such as nornicotine, have neuropharmacologically relevant effects.

Pharmacological aids for smoking cessation

To smokers, nicotine addiction is a powerful vice that is difficult to overcome even with pharmaceutical aids. Relapse rates are high and maintaining a successful quitting strategy is difficult regardless of the method used. Therefore, clinicians should routinely provide positive feedback to help maintain their patients' cessation. Encouraging smoking cessation, selecting appropriate products, and monitoring and supporting patients through their withdrawal symptoms makes for a more complete therapeutic care plan for cessation of tobacco use. In the long term, helping patients to succeed in their cessation treatment has the potential to reduce healthcare costs, save clinicians time and money, and improve morbidity and mortality rates.

In vitro effects of nicotine on mitochondrial respiration and superoxide anion generation

In this study, we investigated the effects of nicotine on rat brain mitochondria. The polarographic studies determined the effects on the respiratory chain, whereas enzymatic assays and [3H]-nicotine binding allowed us to precisely identify its target and site of action. The measurements of oxygen consumption showed a significantly concentration-dependent inhibition by nicotine (EC50 was 4.95x10(-11) M), and a maximal decrease of 23.90% at 10(-7) M. Nicotine bound to complex I of the respiratory chain and inhibited the NADH-Ubiquinone reductase activity. We also showed that nicotine and NADH were competitive on complex I. Effects of cotinine, the main nicotine metabolite, and nornicotine, were also investigated: nornicotine inhibited the mitochondrial respiration whereas cotinine did not. Because the complex I generates superoxide anion, we investigated the effects of nicotine, following NBT oxidation, and showed that nicotine was able to inhibit this reactive oxygen species (ROS) generation by 15.74% with an EC50 of 2.02x10(-11) M. In conclusion, the present study shows that nicotine interacts with the complex I of brain mitochondrial respiratory chain and decreases ROS generation. This may explain a part of the beneficial and protective effects of nicotine in few neurodegenerative diseases, as suggested by many epidemiological studies.

Agonists at the alpha4beta2 nicotinic acetylcholine receptors: structure-activity relationships and molecular modelling

Agonists of the alpha4beta2 nicotinic acetylcholine receptors have been synthesised as potential drugs for treatment of a variety of diseases. In this review, the published nicotinic agonists are presented and, on the basis of the molecular structure, the compounds are divided into three compound classes, nicotinoids (structurally close to nicotine), bicyclic compounds (structurally close to epibatidine and anatoxin-a), and analogues of imidacloprid (structurally close to the insecticide imidacloprid). The structure-activity relationships are discussed within and in between the classes. On the basis of computational studies of ligands for the nicotinic acetylcholine receptors the structure-activity relationships are discussed and a possible binding mode suggested. The binding mode encompasses: (A) an interaction between an anionic site in the receptor and the protonated nitrogen atom in the ligand, (B) a hydrogen bond between a hydrogen bond donor in the receptor and a hydrogen bond acceptor in the ligand, (C) an interaction between a pi-system (heteroaromatic ring, carbonyl bond) in the ligand and another pi-system or a positively charged amino acid residue in the binding site, (D) a pi-cation interaction between aromatic residues in the receptor binding site and the protonated nitrogen atom in the ligand, and (E) steric interactions of positive and negative character around the aliphatic and the heteroaromatic part of the ligand.

Neuronal nicotinic acetylcholine receptor binding affinities of boron-containing nicotine analogues

A series of boron-containing nicotine (NIC) analogues 7-9 was synthesized and evaluated for binding to alpha4beta2 and alpha7 nicotinic receptors. Compound ACME-B inhibited [3H]methyllycaconitine binding to rat brain membranes with a similar potency compared to NIC (Ki = 2.4 and 0.77 microM, respectively), but was markedly less potent in inhibiting [3H]NIC binding when compared to NIC (Ki = 0.60 microM and 1.0 nM, respectively). Thus, tethering a two-carbon bridge between the 2-pyridyl and 3'-pyrrolidino carbons of NIC or 7 affords analogues that bind to the alpha7 receptor in a manner similar to NIC, but with a dramatic loss of affinity for the alpha4beta2 receptor.

Accumulation of nicotine and its metabolites in rat brain after intermittent or continuous peripheral administration of [2'-(14)C]nicotine

Concentrations of nicotine, cotinine, and nornicotine in brain and blood following both intermittent and continuous administration of [2'-(14)C]nicotine to rats were determined to assess nicotine metabolite accumulation in brain following repeated nicotine administration. For intermittent studies, rats were administered s.c. 1 to 10 doses of nicotine (0.3 mg/kg, 15 or 25 microCi of [2'-(14)C]nicotine; 30-min interinjection interval). For continuous administration studies, rats were implanted s.c. with an osmotic minipump delivering nicotine (0.8 mg/kg/day, 25 or 50 microCi of [2'-(14)C]nicotine for 1-21 days). Whole brain and trunk blood was collected. The concentration of [2'-(14)C]nicotine and its metabolites was determined via high-pressure liquid radiochromatography. Brain concentrations of nicotine, cotinine, and nornicotine increased 2-, 12-, and 9-fold, respectively, following 10 injections, reaching a plateau following the fifth injection. Brain blood ratios indicate an enhanced preferential distribution of nornicotine to brain with increasing numbers of injections. Across the 21-day period of continuous infusion, blood nicotine and nornicotine concentrations remained relatively constant, whereas concentrations in brain increased approximately 4-fold. Generally, cotinine concentrations in brain and blood did not change across the infusion period. Brain/blood ratios indicate an increase in nicotine distribution into brain across days of nicotine infusion. Results demonstrate that both nicotine and its metabolites accumulate in brain following repeated nicotine administration, and indicate that brain nicotine concentration can not be extrapolated from plasma cotinine or nicotine concentrations. Thus, nornicotine accumulation following repeated nicotine administration suggests that this metabolite plays a contributory role in the neuropharmacological effects of nicotine.

Effects of smoking cessation and nicotine substitution on systemic eicosanoid production in man

This study investigated the effects of smoking cessation with and without nicotine substitution on the excretion of major urinary metabolites of thromboxane A2 and prostacyclin, 11-dehydrothromboxane B2 and 2,3-dinor-6-ketoprostaglandin F1alpha, respectively, as well as on the excretion of leukotriene E4 in man. Urine samples were obtained from 20 healthy non-smoking controls and from 60 healthy smoking volunteers before, and 3, 7 and 14 days after smoking cessation. Fifteen smokers quit smoking without nicotine substitution, 15 used nicotine chewing gum and 30 used nicotine patches as a substitution therapy. Urinary thiocyanate as well as cotinine and trans-3'-hydroxycotinine excretions were used as compliance and nicotine substitution indicators. 11-Dehydrothromboxane B2, 2,3-dinor-6-ketoprostaglandin F1alpha and leukotriene E4 excretion was about two, three and five times higher in smokers than in controls, respectively. Three days after smoking cessation without nicotine substitution, 11-dehydrothromboxane B2 and 2,3-dinor-6-ketoprostaglandin F1alpha levels were lowered to 75% (P<0.01) and 80% (P<0.05) of the initial values, and after 14 days to 50% (P<0.01) and 60% (P<0.05), respectively. In 3 days leukotriene E4 excretion was dropped to 70% of the initial value (P<0.05), but no further decrease was observed during the study. In individuals using nicotine chewing gum or nicotine patches no significant changes were observed in the analytes during the 2-week follow-up. The increased systemic eicosanoid synthesis observed in smokers may be involved in the harmful cardiovascular effects of smoking. The fact that eicosanoid production remains at pre-cessation level in volunteers who quit smoking but use nicotine substitution may be involved in the risk of cardiovascular complications reported during nicotine replacement therapy.