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Yıl:2004; Cilt: 17; Sayı: 2>> Özet
TAM METİN
Düşünen Adam: Psikiyatri ve Nörolojik Bilimler Dergisi; 2004;17(2):105-108
Sigara bıraktırmada ilaçların etkinliği: Bir gözden geçirme
D Ertemir, M Ertemir
Bu çalışmada sigara bıraktırma tedavileri ile ilgili olarak son 10 sene içinde yapılmış çalışmalar gözden geçirilmiştir. Bu amaçla medline taranmış ve özellikle plasebo kontrollü çift kör yapılmış etkinlik çalışmaları ayrıntılı incelenmiştir. Sonuç olarak sigara bıraktırmada nikotin yerine koyma preparatları, bupropion SR (yavaş salınımlı) ve nortriptilin etkinliği kanıtlanmış farmakolojik tedavilerdir. Nikotin yerine koyma tedavisi ve bupropion SR, yoksunluk belirtileri yanısıra kilo alımını da azaltmaktadır. Bupropion SR, nüksün en sık sebebi olan sigaraya karşı duyulan şiddetli isteği (craving) de azaltmaktadır. Bupropion SR ın özellikle kadınlarda nüksü önlemede etkin olduğunu düşündüren bulgular vardır. Selejilin, lazabemidle yapılan ilk çalışmalarda umut verici sonuçlar elde edilmiştir. Lazabemidle yapılan çalışmada 8. haftada nokta prevalansı sigara bırakma oranları 100 mg lazabemid, 200 mg lazabemid gruplarında sırasıyla % 17, % 19 ve % 30 bulunmuştur. Nikotin yerine koyma tedavisi ile birlikte selejilinin etkinliği araştırılmış, 52 haftalık tedavide NRT + Selejilinle 52 haftalık sürekli bırakma oranı NRT + Plasebo ile görülenin iki katı olmuştur (sırasıyla % 25, % 11), ama sonuç istatistiksel olarak anlamlı değildir. Selejilin ayrıca 'craving'i de azaltmıştır. Kombine ilaç tedavileri başarı oranlarını artırabilir, farklı ilaç kombinasyonlarının denendiği çalışmalar yapılmalıdır.
In this review, the trials of the last 10 [year]s related to smoking cessation therapies are reviewed. For this aim medline is searched and especially the randomized, double-blind, placebo controlled trials are examined in detail. As a result nicotine replacement preparates, bupropion SR and nortriptyline are the pharmacological therapies whose efficacies are proved. Nicotine replacement therapy and bupropion SR reduces withdrawal symptoms as well as weight gain. Bupropion SR also reduces the craving that is the most common reason of relapse. There are some results suggesting that bupropion is effective in preventing relapse especially in women. The results of the first trials of selegiline and lazabemide are giving hope. In the study of lazabemide point prevalance abstinence at the end of 8 week was 17 %, 19 % and 30 % in the placebo, lazabemide 100 mg/day and lazabemide 200 mg/day groups, respectively. In the study of selegiline, adding selegiline to nicotine patch was associated with doubling of the 52-week continuous abstinence rate, but this difference was not statistically significant. Selegiline significantly reduced craving for cigarettes. Combined drug therapies may increase the success rates, new trials with different drug combinations can be done.

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