Pharmacy Articles
Health, Disease, Drugs
Evidence for use of rimonabant for smoking cessation
Oct 15th
Animal evidence
There is evidence that the endocannabinoid system may influence in nicotine’s reward effects in the brain. Studies of the effects of rimonabant using animal models began in 2001, and data have been obtained regarding the potential utility in nicotine dependence. Cohen et al (2005) studied nicotine-seeking behavior in rats. Rats who were given rimonabant displayed decreased nicotine-conditioned behavior as demonstrated by decreasing the self-administration of nicotine and dopamine turnover in the nucleus accumbens after nicotine stimulation. Balerio et al (2006) reported that pretreatment with rimonabant in mice decreased the anxiety-reducing effects of nicotine in mice who had been previously exposed to nicotine. This study supports the link between the endocanabanoid system and nicotine’s anxiety-like behaviors.
Current pharmacotherapies for tobacco dependence treatment
Oct 15th
Pharmacotherapy for tobacco dependence is an important component of a comprehensive treatment plan that includes behavioral interventions and psychosocial support. The primary effects of nicotine are mediated by nicotinic acetylcholine receptors, many subtypes of which are widely distributed throughout the central nervous system. A high concentration of α4 subunits is found in the ventral tegmental area of the brain, where a dense supply of dopamine neurons is linked to the brain’s main “reward center,” the nucleus accumbens. An increase in extra-synaptic dopamine in the extracellular space appears to be associated with the reinforcing and addictive properties not only of nicotine but also of other psychostimulant drugs of abuse (eg, amphetamine, cocaine).
Rimonabant in rats with a metabolic syndrome
Oct 14th
Rimonabant in rats with a metabolic syndrome: good news after the depression
In the industrialized world, the prevalence of obesity has reached epidemic proportions. In the United Kingdom, almost half of the adults will be obese by 2015, and this, the British Medical Journal warns, could bankrupt the National Health Service. Obese people are at high risk of multiple health problems: most importantly, rampant obesity is thought to be responsible for the dramatic rise in the incidence of type II diabetes (T2D). Indeed, abdominal obesity is a key component in the metabolic syndrome (also known as insulin resistance syndrome), a cluster of metabolic disorders (including large waistlines, high triglycerides and fasting glucose, low high-density lipoprotein cholesterol and high blood pressure) that often precedes T2D. The molecular pathogenesis of the metabolic syndrome is complex and poorly understood. At the clinical level, patients with this cluster of disorders have atherogenic inflammation and are in a pro-thrombotic state. Consequently, coronary artery disease and other potentially fatal cardiovascular thrombotic events (for example, stroke and peripheral vascular disease) are also common, justifying a new definition of the metabolic syndrome as a part of the global ‘cardiometabolic’ risk. In particular, high abdominal (‘apple-like’) obesity and visceral fat have been linked to the metabolic syndrome. Reversal of the rising trend in the prevalence of obesity is of the utmost importance. Unfortunately, many people are unable to lose their excess weight by diet and exercise alone. Therefore, medical practice must adapt to the obesity epidemic by developing new pharmacological and surgical (for example, bariatric surgery) interventions and by addressing the problem of visceral obesity and related metabolic disorders. The antagonism of cannabinoid CB1 receptors is one example of such strategies, although with some complications.
Epidemiology of smoking
Oct 14th
Tobacco use remains one of the leading causes of preventable death in the world. Despite tobacco’s highly addictive nature, the majority of current smokers are interested in quitting. Even with this seeming demand for assistance with stopping tobacco use, it is unclear how well tobacco cessation treatments are being utilized. Over the past 20 years, various cessation medications have become available to improve success for those smokers making a quit attempt. Currently, the United States Food and Drug Administration (FDA) has approved 7 medications as first-line treatments for smoking cessation (Table 1). Despite these effective products, overall abstinence rates even with a comprehensive approach generally fall well below 40% 1 year after the target quit-date. As novel cessation medications enter the market, clinicians have a wider range of tools to assist smokers with their efforts, and the ability to tailor a medication treatment plan to the individual needs of the patient.