La substitution nicotinique dans l'aide au sevrage tabagique. Modes d'action, modalités et appréciation des résultats.

Failure in smoking cessation is linked with behavioural factors and with nicotine dependence, due to the psychoactive effects of the drug, mainly on locus ceruleus and on mesolimbic dopaminergic system. Nicotine substitution partially controls the withdrawal syndrome, sometimes very intense in smokers with pharmacological dependence. After transdermal nicotine administration, nicotine blood levels are relatively low but steady; nicotine chewing gum can be used alone or in combination with transdermal administration. Both methods can double biologically controlled success rates. Risks are limited in comparison with those of continued smoking. Recent data from the literature allow a better understanding of indications and limits of the pharmacological approach to cessation, that should address smokers firmly decided to stop, and be completed by behavioural support, including changes in the way of life