An update on nicotine replacement therapy

Smoking: Pathogenetic Mechanisms, Possibilities of Medical Correction (Literature Review)

The smoking epidemic is one of the greatest threats to human health, as it is the leading cause of death worldwide, as well as many preventable diseases. Diseases associated with smoking include cardiovascular disease, atherosclerosis, type 2 diabetes, chronic pancreatitis, chronic obstructive pulmonary disease, cancer, osteoporosis and others. The aim is to analyze information on the pathogenetic mechanisms of tobacco exposure and methods of its drug correction. Among the 4,000 chemicals identified in tobacco smoke, nicotine is the main active ingredient in tobacco products. It is highly toxic and potentially lethal. Nicotine affects many systems, including the neurological, neuromuscular, cardiovascular, respiratory, immunological and gastrointestinal systems. Therefore, nicotine-containing drugs reduce the symptoms of nicotine withdrawal in regular smokers who abstain from smoking. The presence of different types of nicotinic acetylcholine receptors, their regulation and desensitization affect these complex physiological effects. Nicotine replacement drugs contain pure nicotine, in order to reduce the patient’s propensity to use tobacco, physiological and psychomotor withdrawal symptoms. They increase the level of nicotine in the blood, thus facilitating the transition from cigarette smoking to complete abstinence. Smokers can quit without using nicotine-containing drugs, but most those who try do not succeed on the first try. Nicotine replacement drugs only affect physical dependence. Nicotine is the main factor responsible for dependence on cigarette smoking, and its rate of absorption and entry into the brain are considered key factors responsible for the high potential for abuse of this drug. The advantage of nicotine-containing drugs is the patient’s independence from the method of administration, determination of abstinence, duration of treatment, level of supportive counseling, place of treatment (hospital, clinic or support group), as well as fixed, variable or reduced doses. There are a number of nicotine-containing drugs in various forms that effectively promote smoking cessation in adults.

Nicotine replacement therapy: A friend or foe

According to the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC), tobacco cessation is a primary health-care service that should be provided not only to the people having adverse habits of consuming tobacco but also to the nonconsumer, as they can also be harmed due to its deleterious effects. Tobacco has been regarded as a potential risk factor for oral diseases such as oral potentially malignant disorders and oral cancers. Various aids of achieving cessation have been studied, including education of the ill effects of tobacco to the patient, behavioral counseling, and pharmacotherapy. Various pharmacological interventions are available nowadays but nicotine replacement therapy (NRT) is most widely used. The various types of NRT products results in general and breakthrough craving relief with immediate release of nicotine. All of these products have different levels of efficacy and variable rates of nicotine absorption. Knowledge of these will be beneficial for the patients, the budding dentist and the nation in the upcoming days ahead.