N-acetylcysteine for therapy-resistant tobacco use disorder: a pilot study.
Reviewer: Alan Gaby, MD
Author: Prado E, et al
Reference: N-acetylcysteine for therapy-resistant tobacco use disorder: a pilot study. Redox Rep 2015;20:215-222.
Design: Randomized, double-blind, placebo-controlled trial.
Participants: Thirty-four patients (mean age, 51 years) with therapy-resistant tobacco addiction
Study Medication and Dosage: N-Acetylcysteine (NAC) at a dose of 1,500 mg twice a day (morning and evening) or placebo for 12 weeks. All patients received smoking-focused group behavioral therapy.
Primary Outcome Measure: Quitting smoking (defined as exhaled carbon monoxide concentration of less than 6 parts per million).
Key Findings: The proportion of patients who quit smoking was significantly higher in the NAC group than in the placebo group (47.1% vs. 21.4%; p < 0.01). In addition, compared with placebo, NAC significantly decreased (improved) the mean score on the Hamilton Depression Rating Scale.
Practice Implications: There is evidence that a subnormal concentration of glutamate in the nucleus accumbens region of the brain increases compulsive or addictive behaviors. Administration of NAC has been shown to increase glutamate concentrations in the nucleus accumbens. In previous studies, NAC showed promise as a treatment for cocaine addiction, nicotine addiction, cannabis dependence, methamphetamine craving, and pathological gambling. The results of the present study suggest that NAC, as an adjunct to behavioral therapy, may also help some individuals to quit smoking.
Reviewer: Alan Gaby, MD
