An update on therapeutics for tobacco dependence.

The aim of this review is to consider the clinical trial evidence for the efficacy of four classes of pharmacological treatment for nicotine dependence: nicotine replacement, antidepressants, nicotine-receptor partial agonists and drugs blocking cannabinoid receptors. Despite falls in many developed countries, the prevalence of smoking remains high and is increasing in developing countries. Stopping smoking before middle age substantially reduces the mortality associated with tobacco use. Although many people quit without formal help, both non-pharmacological and pharmacological interventions can help people to stop smoking. Drug therapies target neural pathways to reduce withdrawal symptoms associated with psychopharmacological dependence on nicotine. Nicotine replacement therapy and some antidepressants aid smoking cessation and are an established part of therapy. Newer pharmacological approaches include the use of the selective nicotinic partial agonists, varenicline and cytisine, and compounds targeting cannabinoid receptors (rimonabant). Recent evidence suggests that the nicotine-receptor partial agonist varenicline is at least as effective as nicotine replacement therapy and antidepressants.