Pfizer launches dual-mode therapy to block nicotine's effect in the brain.

Let's quit

Pfizer launches dual-mode therapy to block nicotine's effect in the brain.

PFIZER Malaysia recently launched its new smoking cessation pill, varenicline, a

breakthrough non-nicotine oral medication. It has a novel mechanism of action which helps smokers quit smoking by providing dual benefits.

Varenidine is unique because it is specifically designed to partially activate the nicotinic receptor and reduce the severity of the smoker's craving and the withdrawal symptoms from nicotine.

Moreover, if a person smokes a cigarette while receiving treatment, it has the potential to diminish the sense of satisfaction associated with smoking.

This assists the attempting quitter by helping prevent the cycle of nicotine dependence.

Nicotine dependence makes quitting smoking very difficult and is one of the main reasons many smokers do not succeed in their attempts to quit.

When smokers inhale smoke from a cigarette, nicotine reaches the brain within seconds and binds to nicotinic receptors, which activates the reward pathway in brain circuitry. This stimulates the pleasure centre in the brain.

However, the initial effects of pleasure recede quickly. The rewards-or pleasurable effects rein-force a smokers' physical dependence on the nicotine contained in cigarettes.

Smokers then become accustomed to certain levels of nicotine in their systems and a drop in these nicotine levels results in a cycle of craving and uncomfortable with-drawal.

"Pfizer's discovery and development ofvamnicline demonstrates groundbreaking science leading to the first treatment aimed directly at smoking cessation," said Dr Wong

Kok Seng. Medical Director, Pfizer Malaysia, Singapore and Bmnei. "Smoking harms nearly every organ in the body and is a preventable cause of death. This innovahve

medication will now help many smokers end their nicotine dependence and enjoy healthier and happier lives."

In two identically designed varenicline studies, patients receiving a 12-week course of varenicline therapy ( lmg twice daily) nearly quadrupled the likelihood of quitting than those taking placebo and had nearly twice the likelihood of quitting than those patients taking buproprion (150rag twice daily).

Varenicline also demonstrated a favourable safety and tolerability profile in studies of almost 4,000 smokers.

"These results suggest varenidine is a significant advancement in the management of smoking cessation," said Dr Wang. "It is never too late to quit smoking. People who quit smoking before the age of 50 have one-half the risk of dying of a smoking-related illness in the next 15 years compared to those who continue smoking. Smokers who are unable to quit on their own should consider seeking medical support and treatment."

In trials, vareuicline was generally well tolerated, with overall discontinuation rates similar to placebo. The most common side effects included nausea, vivid dreams, headaches and vomiting.

"As everyone knows, it is extremely difficult to quit smoking," said Dr Wang. "For example, less than 7% of smokers who try to quit on their own achieve more than one year of abstinence. In fact, most smokers begin smoking again within a few days of attempting to quit. It takes about five to seven attempts -with or without treatment - before the average smoker is able to quit."

Because smokers need considerable support to successfully quit their dependency on nicotine, a support programme known as the Quitting Championship designed to help address behavioural components of smoking dependence will be made available to patients.

Recognising the need for greater awareness of the role of medical therapy in quitting smoking, Pfizer wil! also be making available to the public a Quitter's Guide, which provides information on the different options for smoking cessation therapy available in Malaysia.

"Varenicline represents Pfizer's commitment towards working together for a healthier world through applying innovative science to improve the quality of life for patients," said Dr Wang.

Unlike other smoking cessatior solutions that work only on controlling the withdrawal symptoms, varenicline reduces craving and withdrawal symptoms as well as the smoker's sense of satisfaction derived from smoking.

Both nicotine and varenicline act on the nicotinic acetylcholine receptors (nAChRs) in the brain, which is associated with nicotine dependence.

However unlike nicotine, varenicline is a partial agonist of the receptors.

References:

1. Conzales DH, Rennard SI, Billing CB, Reeves KR. A pooled analysis of varenicline, an a462 nicotinic receptor partial ogonist versus bupmpion for smoking cessation. Presented at Surety for Research on Nicotine and Tobacco, February 2006.

2. Jorenby DE, Hays ff, Rigotfi NA, et al, for the Varenidine Phase 3 Study Group. Efficacy of varenidine, an a462 nicotinic acetylcboline receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled triaIJAMA. 2006;296:56-63.

3. Tonstad S, Hays JT, Jorenby DE, Reeves K. Billing 13, Gong J, Azoulay

5. Smoking cessation efficacy and safety of an o462 nicotinic receptor partial agonist - results from varenidine in cessation therapy: optimizing results. Presented at American Heart Association, November 2005.

One puff above the limit

By Dr BERNADINE HEALY

One puff above the limit PEST easier, robbers. The cops have some new villains to track down. They're called smokers. Recently, police in Bangor, Maine, took on the job of ticketing people spotted puffing on cigarettes in their cars if children under l8 are on board.

Last year, Arkansas and Louisiana enacted similar bans, and many other states, including New Jersey. New York, California, Kansas, and Utah, are considering them. Some propose fines as high as U55500 (RM1,750) and jail time.

To be sure, public policies like advertising bans and smoke-free public places have been highly effective in reducing exposure to second-hand smoke. And the goal of these new laws is just as laud

able.

But this particular anti-smoking campaign has more than libertarians concerned that government is

going too far in policing behaviour and trouncing privacy. Next, the health police could ticket parents

for buying children junk food or for letting them get too much sun at the beach. A more practical and

immediate concern however, may be whether enlisting the police to punish smokers will improve children's health.

Smoking is an ugly habit. It pollutes the air with toxic vapours that can be inhaled by innocent bystanders. This seems to explain why non smoking spouses of smokers face a small but increased

chance of lung cancer.

For children, as pointed out by the US surgeon general's 2006 report The Health Consequences of

Involuntary Exposure to Tobacco Smoke, homes filled with smoke increase youngsters' risk of respiratory problems like bronchitis, pneumonia, and asthma attacks. The report also revealed that Mom's smoking has a greater negative effect than Dad's.

But it's not just smoking during pregnancy that can do damage, The lungs of infants and toddlers

are also vulnerable to passive smoke, a risk that trails off and disappears as children grow older and

move into their teens, What does not disappear, however, is a child's risk of becoming an active smoker, facing a greater chance of cancer and heart disease later on in life.

There are few data on smoking in cars per se. The danger is inferred because of smoke concentration in a contained space. You might also infer that people so into their cigarettes that they have to light up in the confines of a ear represent a pretty hard-core group of smokers.

Smoking them out of their cars will only drive these tobacco addicts to light up more in their kitchens and faSrnily rooms, out of Light or reach of the health police.

But even among those who have not yet become addicted, the threat of a ticket may not be a deterrent. Over the past 20 years, more than 30 states in the United States have enacted laws imposing hefty fines, court appearances, loss of driver's licenses, school suspensions, or other penalties on teenagers caught buying, possessing, or using tobacco.

But these penances haven't worked very well, Neither policy-makers nor police are enthusiastic

about punitive approaches, and the laws are often enforced in an erratic and seemingly selective

way.

This suggests another problem for the smoking police: The odds are that the adults they will be singling out for smoking in cars with underage passengers will be disproportionately poor, uneducated,

and female, as today's smokers are tilted toward lower incomes and less formal schooling. And even

though more men smoke than women, more often than not, women will be the ones ferrying young children around in cars, They're called Morns. So be real. Will a fine or 30 days in jail improve the well-being of these often disadvantaged mothers and their children7

A former professor of mine used to preach that when she's caring for a child, be sure to "build up

Momma". Remember to tell her what a good job she's doing, and help her when she may be struggling. Momma is the one who bears the major responsibility for young children, day in and day out.

5be - no offense, Dads is the one who typically sets the tone for health behaviour in the home.

Yet young women are tailing up smoking in droves, and in what seems to be a curious fact of gender biology, once hooked it's harder for them to quit than men. Women respond differently to

smoking cessation programs and may also face more intense withdrawal s3rinpt ores..

Most parents who smoke want to give it up and sure don't want their kids to start. Morns may be

just the pressure point for Change. But don't punish them. Encourage, educate, and motivate them, and

provide program tailored to assist them in kicking their addiction. He p smokers become better

mothers. And let health experts, not cops walk the smoking beat, US News and World Report/Premium health News Services/TMSI