Pharmakologische Möglichkeiten der Rückfallprophylaxe bei Nikotinabhängigkeit^[*]

Zusammenfassung

Die Nikotinersatztherapie (Pflaster, Kaugummi oder Spray) hat einen wichtigen Stellenwert in der Behandlung der Nikotinsucht. Die damit erzielten Abstinenzquoten nach sechs bis zwölf Monaten schwanken je nach Darreichungsform zwischen 5 und 25%. Die Wirksamkeit dieser Verfahren beruht auf einer Reduktion von Entzugserscheinungen durch Stimulation der nikotinischen ACh-Rezeptoren. Als erste nicht-nikotinhaltige Substanz erhielt Bupropion SR (»slow release«) die Zulassung zur Raucherentwöhnung. In einer kontrollierten Studie waren ein Jahr nach Therapieende mit diesem selektiven Dopamin- und Noradrenalin-Wiederaufnahmehemmer noch 30% der Patienten abstinent. Somit stehen nun mehrere viel versprechende Ansätze zur Rückfallprophylaxe bei Nikotinabhängigkeit zur Verfügung.

Summary

Nicotine replacement therapy (patches, gum, or spray) is effective part of a pharmacological strategy to treat nicotine dependence. Meta-analyses have demonstrated 6-12 month absistence rates between 5 and 25%, depending on the mode of application and on the given dose. With increasing knowledge of mechanisms how nicotine interacts with the central nervous system, a variety of non-nicotine drugs has been tested for smoking cessation. Bupropion SR (slow release) was the first medicine as non-nicotine drug for treatment of nicotine dependence. Bupropion which selectively blocks noradrenaline and dopamine re-uptake has proven to be successful with abstinence rates of 30% after 12 months treatment. Thus, several compelling therapeutic strategies exist in pharmacological treatment of nicotine dependence.

Schlüsselwörter

Nikotin - Nikotinabhängigkeit - Nikotinersatztherapie - nikotinhaltige Medikamente - nikotinfreie Medikamente - Raucherentwöhnung

Keywords

Nicotine - nicotine dependence - nicotine replacement therapy - nicotine drugs - non-nicotine drugs - smoking cessation

^* aktualisierte Fassung der Arbeit: Schön S, Nowak D. Medikamentöse Verfahren zur Raucherentwöhnung. Suchtmed 2002; 4: 189-99.

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