Use of beta-blocking agents with group therapy in a smoking withdrawal clinic. Efficacy of buspirone in smoking cessation: a placebo-controlled trial. A placebo-controlled evaluation of the effects of buspirone on smoking cessation: differences between high- and low-anxiety smokers. One-year follow-up results of a smoking cessation program. Comparison of fixed-dose transdermal nicotine, tapered-dose transdermal nicotine, and buspirone in smoking cessation.
A controlled trial was carried out into the relative efficacy of two beta-blocking agents (oxprenolol and metoprolol) as adjuncts to group therapy in a smoking withdrawal clinic. There was no evidence to indicate that these were of specific value in assisting smoking withdrawal. Buspirone, a non-sedating anxiolytic, has yielded contradictory results in smoking cessation pilot studies and trials. We tested buspirone (n = 51) versus placebo (n = 49) in a placebo-controlled, double-blind trial of smoking cessation. Survival analyses were performed with use of strict abstinence criteria for efficacy (carbon monoxide levels < or = 8 ppm; no self-reported slips to smoking). No treatment differences were observed between active and placebo groups. There were also no differences among "anxiety" level groups formed post hoc from high versus low, pre-quit anxiety test scores. A number of withdrawal symptoms increased significantly after subjects quit smoking for both the active drug and placebo groups, but these symptoms were not relieved by treatment. There appears to be little evidence that buspirone is effective in smoking cessation or in the relief of withdrawal associated with cessation in a general sample. Selecting for generalized anxiety or anxiety related to cessation is suggested for future testing. One hundred one smokers were divided into high and low trait anxiety groups on the basis of a normalized score on the Profile of Mood States Anxiety/Tension Scale and were randomly assigned to receive buspirone or placebo in a double-blind fashion. After a 1-week baseline, smokers were exposed to an 8-week drug and behavioral intervention involving buspirone or placebo (up to 60 mg/day) with concurrent group cognitive behavioral intervention. All smokers were to quit smoking on the target date, set at 4 weeks after the program began. Medication was provided for an additional 4 weeks after group treatment ended. The results showed that buspirone had a beneficial effect on smoking abstinence but only among smokers who were already relatively high in anxiety and only for as long as the drug was available. Moreover, when provided to smokers who were relatively low in anxiety, the drug appeared to interfere with abstinence, although these effects also reversed when the drug was withdrawn. These effects were associated with an attenuation of the expected rise in anxiety before the quit date and its actual reversal thereafter, but only in the buspirone high-anxiety group. One-month abstinence averaged 88, 61, 60, and 89% for the buspirone high-anxiety, placebo high-anxiety, buspirone low-anxiety, and placebo low-anxiety groups, respectively. By 12 months, abstinence for the buspirone and placebo high- and low-anxiety groups fell to 12, 23, 41, and 36%, respectively. No differences were observed for measures of self-efficacy, symptoms of withdrawal, medication side effects, or compliance. nan The authors compared the outcome of 208 smokers treated with fixed-dose transdermal nicotine (n = 69), tapered-dose transdermal nicotine (n = 71), or buspirone (n = 68). At baseline, there were no significant differences among the three treatment groups with regard to age, gender, educational level, duration of smoking, number of cigarettes smoked per day, concomitant disease states or drug use, or Fagerstrom score. All smokers participated in a behavior modification program. Fixed-dose transdermal nicotine was given at a dose of 21 or 22 mg/day for 6 weeks. Tapered-dose transdermal nicotine was given at a dose of 21 or 22 mg/day for 4 weeks, 14 mg/day for 4 weeks and 7 mg/day for 4 weeks. Both transdermal nicotine regimens were initiated on the evening before the attempted quit date. Buspirone was started 21 days before the quit attempt and continued for 7 days after the quit attempt. Buspirone was initiated at 5 mg TID for 7 days and then 10 mg TID for 21 days. Smoking cessation was assessed by patient diaries and random plasma thiocyanate determinations. Dropouts for any reason were considered treatment failures. Quit rates were as shown in the Table I. Discontinuation of treatment for perceived side effects and dropouts for all reasons were not significantly different among the treatment groups. The authors conclude that fixed-dose transdermal nicotine, tapered-dose transdermal nicotine, and buspirone are associated with similar efficacy and safety when combined with behavior modification in smoking cessation.
There is no consistent evidence that anxiolytics aid smoking cessation, but the available evidence does not rule out a possible effect.