NRT = nicotine replacement therapy

NRT improves quitting success rates and reduces cessation-induced weight gain. It’s a fact; and there are a lot of anti-addictive pharmacological interventions that do too.

Dear obesity researchers, primary care physicians, and smokers,
Pay attention.
Sincerely,
Bill

Rimonabant is the anti-“munchies” drug that blocks the marijuana receptor CB1. It causes weight loss. But 20 mg daily also increases the odds of successfully quitting smoking by 50 – 60% (Cahill and Ussher, 2007).

Relevance?
Marijuana: not really addictive.
Obesity diets: delicious, but not really addictive.
Cigarettes: definitely addictive.
Rimonabant: anti-addictive. It causes weight loss in overweight but not lean people, perhaps because lean people don’t eat obesity diets (?).

The addition of a 21 mg nicotine patch to 20 mg rimonabant resulted in a 39% quitting success rate whereas rimonabant alone was 21.3%. AND the NRT+rimonabant group gained less weight (0.49 vs. 0.04 kg) (Rigotti et al., 2009). Cold turkey = weight gain + relapse.

Is it possible that cessation-induced weight gain causes relapse? That’d be difficult to dissect scientifically, but there’s undoubtedly a link between the two.

Naltrexone, an opiate antagonist used in the treatment of alcohol and opiate dependence, also improves quitting success. When added to a 21 mg nicotine patch, naltrexone almost tripled quitting success rates. AND it reduced cessation-induced weight gain (O’Malley et al., 2006):

side note: naltrexone but not acamprosate is more efficacious at reducing alcohol intake in smokers than in non-smokers (Mason et al., 2009; Fucito et al., 2012); naltrexone but not acamprosate reduces body weight (McElroy et al., 2011). I have no idea what this means, but it seems relevant.

NRT dose is important. Nicotine patches of 7, 14, and 21 mg produce plasma nicotine levels of 6, 12, and 17 ng/mL, respectively; snus and nicotine gum provide around 10 ng/mL; and one cigarette gets you anywhere up to 25 ng/mL; slightly lower for e-cigarettes (Goniewicz et al., 2012). One study comparing all three doses of the patch showed a dose-dependent reduction in food intake, which significantly blunted cessation-induced weight gain (Hughes and Hatsukami, 1997).

Varenicline, the new player on the block, an a4b2 nicotinic partial agonist, improves success rates and reduces cessation-induced weight gain (Tonneson and Mikkelsen, 2012):

see a link here? Interventions that reduce cessation-induced weight gain improve quitting success… or interventions that improve quitting success reduce cessation-induced weight gain (?).