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Effects of Transdermal Clonidine Treatment on Withdrawal Symptoms Associated With Smoking Cessation: A Randomized, Controlled Trial

Effects of Transdermal Clonidine Treatment on Withdrawal Symptoms Associated With Smoking... Abstract • In a double-blind, randomized, placebo-controlled trial, we studied 40 cigarette smokers to determine the effects of one week of transdermal clonidine hydrochloride (Catapres-TTS No. 2) treatment on the withdrawal symptoms associated with smoking cessation. Subjects were instructed to maintain their usual cigarette intake during days 1 through 3 and cease smoking for days 4 through 6. All of the withdrawal symptoms measured (craving, irritability, anxiety, restlessness, difficulty concentrating, and hunger) significantly increased during the three days of smoking cessation in the placebo group. There was a 4.3-fold increase in craving, a 3.8-fold increase in irritability, a 3.7-fold increase in anxiety, and a 3.3-fold increase in restlessness in the placebo group compared with the transdermal clonidine group during the three days of smoking cessation. Impairment of concentration and hunger were not significantly diminished by transdermal clonidine treatment during smoking cessation. In addition, a trend was present in the transdermal clonidine group to spontaneously decrease the number of cigarettes smoked per day during the smoking period. Side effects were generally mild. We conclude that transdermal clonidine treatment ameliorates some of the short-term withdrawal symptoms, especially craving, associated with smoking cessation. (Arch Intern Med 1988;148:2027-2031) References 1. Fielding JE: Smoking: Health effects and control (first of two parts). N Engl J Med 1985;313:491-498.Crossref 2. Fielding JE: Smoking: Health effects and control (second of two parts). N Engl J Med 1985;313:555-561.Crossref 3. Miller EF: Treatment of tobacco dependence. N Engl J Med 1985;313:1233-1234.Crossref 4. Hughes JR, Hatsukami D: Signs and symptoms of tobacco withdrawal. Arch Gen Psychiatry 1986;43:289-294.Crossref 5. Hughes JR, Gust SW, Pechcek TF: Prevalence of tobacco dependence and withdrawal. Am J Psychiatry 1987;144:205-208. 6. Benowitz NL, Jacob P, Kozlowski LT, et al: Influence of smoking fewer cigarettes on exposure to tar, nicotine, and carbon monoxide. N Engl J Med 1986;315:1310-1314.Crossref 7. Rose JE, Herskovic JE, Trilling YS, et al: Transdermal nicotine reduces cigarette craving and nicotine preference. Clin Pharmacol Ther 1985;38:450-456.Crossref 8. Bailey BJ: Tobaccoism is the disease—cancer is the sequela. JAMA 1986;255:1923-1924.Crossref 9. Nicotine Gum. Med Lett Drugs Ther 1984;26:47-48. 10. Blum A: Nicotine chewing gum and the medicalization of smoking. Ann Intern Med 1984;101:121-123.Crossref 11. Hughes JR, Hatsukami DK, Skoog KP: Physical dependence on nicotine in gum: A placebo substitution trial. JAMA 1986;255:3277-3279.Crossref 12. Jarvik ME, Schneider NG: Degree of addiction and effectiveness of nicotine gum therapy for smoking. Am J Psychiatry 1984;141:790-791. 13. Schneider NG, Jarvik ME, Forsythe AB, et al: Nicotine gum in smoking cessation: A placebo-controlled, double-blind trial. Addict Behav 1983;8:253-261.Crossref 14. Puska P, Bjorkqvist S, Koskela K: Nicotine-containing chewing gum in smoking cessation: A double blind trial with half year follow-up. Addict Behav 1979;4:141-146.Crossref 15. Jamrozik K, Fowler G, Vessey M, et al: Placebo controlled trial of nicotine chewing gum in general practice. Br J Med 1983;289:794-797.Crossref 16. Comparison of four methods of smoking withdrawal in patients with smoking related diseases: Report by a subcommittee of the Research Committee of the British Thoracic Society. Br J Med 1983;286:595-597.Crossref 17. Fee WM, Steward MJ: A controlled trial of nicotine chewing gum in a smoking withdrawal clinic. Practitioner 1982;226:148-151. 18. Jasinski DR, Rolley JE, Kocher TR: Clonidine in morphine withdrawal: Differential effects on signs and symptoms. Arch Gen Psychiatry 1985;42:1063-1066.Crossref 19. Gold MS, Redmond DE, Kleber HD: Clonidine blocks acute opiate-withdrawal symptoms. Lancet 1978;2:599-602.Crossref 20. Gold MS, Pottash AC, Sweeney DR, et al: Opiate withdrawal using clonidine: A safe, effective, and rapid nonopiate treatment. JAMA 1980;243:343-346.Crossref 21. Glassman AH, Jackson WK, Walsh BT, et al: Cigarette craving, smoking withdrawal, and clonidine. Science 1984;226:864-866.Crossref 22. Clonidine soothes smoking withdrawal. Hosp Tribune 1986;18:6. 23. Weber MA, Dryer JI, McMahon FG, et al: Transdermal administration of clonidine for treatment of high blood pressure. Arch Intern Med 1984;144:1211-1213.Crossref 24. Shaw JE: Pharmacokinetics of nitroglycerin and clonidine delivered by the transdermal route. Am Heart J 1984;108:217-223.Crossref 25. Weber MA, Dryer JI: Clinical experience with rate-controlled delivery of antihypertensive therapy by a transdermal system. Am Heart J 1984;108:231-236.Crossref 26. American Psychiatric Association: Quick Reference to the Diagnostic Criteria From Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 27. Zealley AK, Aitken RC: Measurement of mood. Proc R Soc Med 1969;62:993-996. 28. Aitken RC: Measurement of feelings using visual analogue scales. Proc R Soc Med 1969;62:989-993. 29. Hughes JR, Hatsukami D, Pickens R, et al: Effects of nicotine on the tobacco withdrawal syndrome. Psychopharmacology 1984;83:82-87.Crossref 30. Foote SL, Bloom FE, Aston-Jones, G: Nucleus locus ceruleus: New evidence of anatomical and physiological specificity. Physiol Rev 1983;63:844-914. 31. Egan TM, North RA: Actions of acetylcholine and nicotine on rat locus ceruleus neurons in vitro. Neuroscience 1986;19:565-571.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Effects of Transdermal Clonidine Treatment on Withdrawal Symptoms Associated With Smoking Cessation: A Randomized, Controlled Trial

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References (34)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1988.00380090095023
Publisher site
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Abstract

Abstract • In a double-blind, randomized, placebo-controlled trial, we studied 40 cigarette smokers to determine the effects of one week of transdermal clonidine hydrochloride (Catapres-TTS No. 2) treatment on the withdrawal symptoms associated with smoking cessation. Subjects were instructed to maintain their usual cigarette intake during days 1 through 3 and cease smoking for days 4 through 6. All of the withdrawal symptoms measured (craving, irritability, anxiety, restlessness, difficulty concentrating, and hunger) significantly increased during the three days of smoking cessation in the placebo group. There was a 4.3-fold increase in craving, a 3.8-fold increase in irritability, a 3.7-fold increase in anxiety, and a 3.3-fold increase in restlessness in the placebo group compared with the transdermal clonidine group during the three days of smoking cessation. Impairment of concentration and hunger were not significantly diminished by transdermal clonidine treatment during smoking cessation. In addition, a trend was present in the transdermal clonidine group to spontaneously decrease the number of cigarettes smoked per day during the smoking period. Side effects were generally mild. We conclude that transdermal clonidine treatment ameliorates some of the short-term withdrawal symptoms, especially craving, associated with smoking cessation. (Arch Intern Med 1988;148:2027-2031) References 1. Fielding JE: Smoking: Health effects and control (first of two parts). N Engl J Med 1985;313:491-498.Crossref 2. Fielding JE: Smoking: Health effects and control (second of two parts). N Engl J Med 1985;313:555-561.Crossref 3. Miller EF: Treatment of tobacco dependence. N Engl J Med 1985;313:1233-1234.Crossref 4. Hughes JR, Hatsukami D: Signs and symptoms of tobacco withdrawal. Arch Gen Psychiatry 1986;43:289-294.Crossref 5. Hughes JR, Gust SW, Pechcek TF: Prevalence of tobacco dependence and withdrawal. Am J Psychiatry 1987;144:205-208. 6. Benowitz NL, Jacob P, Kozlowski LT, et al: Influence of smoking fewer cigarettes on exposure to tar, nicotine, and carbon monoxide. N Engl J Med 1986;315:1310-1314.Crossref 7. Rose JE, Herskovic JE, Trilling YS, et al: Transdermal nicotine reduces cigarette craving and nicotine preference. Clin Pharmacol Ther 1985;38:450-456.Crossref 8. Bailey BJ: Tobaccoism is the disease—cancer is the sequela. JAMA 1986;255:1923-1924.Crossref 9. Nicotine Gum. Med Lett Drugs Ther 1984;26:47-48. 10. Blum A: Nicotine chewing gum and the medicalization of smoking. Ann Intern Med 1984;101:121-123.Crossref 11. Hughes JR, Hatsukami DK, Skoog KP: Physical dependence on nicotine in gum: A placebo substitution trial. JAMA 1986;255:3277-3279.Crossref 12. Jarvik ME, Schneider NG: Degree of addiction and effectiveness of nicotine gum therapy for smoking. Am J Psychiatry 1984;141:790-791. 13. Schneider NG, Jarvik ME, Forsythe AB, et al: Nicotine gum in smoking cessation: A placebo-controlled, double-blind trial. Addict Behav 1983;8:253-261.Crossref 14. Puska P, Bjorkqvist S, Koskela K: Nicotine-containing chewing gum in smoking cessation: A double blind trial with half year follow-up. Addict Behav 1979;4:141-146.Crossref 15. Jamrozik K, Fowler G, Vessey M, et al: Placebo controlled trial of nicotine chewing gum in general practice. Br J Med 1983;289:794-797.Crossref 16. Comparison of four methods of smoking withdrawal in patients with smoking related diseases: Report by a subcommittee of the Research Committee of the British Thoracic Society. Br J Med 1983;286:595-597.Crossref 17. Fee WM, Steward MJ: A controlled trial of nicotine chewing gum in a smoking withdrawal clinic. Practitioner 1982;226:148-151. 18. Jasinski DR, Rolley JE, Kocher TR: Clonidine in morphine withdrawal: Differential effects on signs and symptoms. Arch Gen Psychiatry 1985;42:1063-1066.Crossref 19. Gold MS, Redmond DE, Kleber HD: Clonidine blocks acute opiate-withdrawal symptoms. Lancet 1978;2:599-602.Crossref 20. Gold MS, Pottash AC, Sweeney DR, et al: Opiate withdrawal using clonidine: A safe, effective, and rapid nonopiate treatment. JAMA 1980;243:343-346.Crossref 21. Glassman AH, Jackson WK, Walsh BT, et al: Cigarette craving, smoking withdrawal, and clonidine. Science 1984;226:864-866.Crossref 22. Clonidine soothes smoking withdrawal. Hosp Tribune 1986;18:6. 23. Weber MA, Dryer JI, McMahon FG, et al: Transdermal administration of clonidine for treatment of high blood pressure. Arch Intern Med 1984;144:1211-1213.Crossref 24. Shaw JE: Pharmacokinetics of nitroglycerin and clonidine delivered by the transdermal route. Am Heart J 1984;108:217-223.Crossref 25. Weber MA, Dryer JI: Clinical experience with rate-controlled delivery of antihypertensive therapy by a transdermal system. Am Heart J 1984;108:231-236.Crossref 26. American Psychiatric Association: Quick Reference to the Diagnostic Criteria From Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 27. Zealley AK, Aitken RC: Measurement of mood. Proc R Soc Med 1969;62:993-996. 28. Aitken RC: Measurement of feelings using visual analogue scales. Proc R Soc Med 1969;62:989-993. 29. Hughes JR, Hatsukami D, Pickens R, et al: Effects of nicotine on the tobacco withdrawal syndrome. Psychopharmacology 1984;83:82-87.Crossref 30. Foote SL, Bloom FE, Aston-Jones, G: Nucleus locus ceruleus: New evidence of anatomical and physiological specificity. Physiol Rev 1983;63:844-914. 31. Egan TM, North RA: Actions of acetylcholine and nicotine on rat locus ceruleus neurons in vitro. Neuroscience 1986;19:565-571.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Sep 1, 1988

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