The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

RIMONABANT: A REVIEW OF A NEW DRUG FOR SMOKING CESSATION AND ITS EFFECT ON AN ENDOGENOUS SIGNALING SYSTEM: THE ENDOCANNABINOID SYSTEM

Mary P. Martinasek, BS, RRT, Robert J. McDermott, PhD
Hillsborough Community College, Tampa, Florida
University of South Florida's College of Public Health
Tampa, Florida

Background: Tobacco use is one of the most modifiable risk factors associated with chronic lung disease and premature death, and continues its high ranking among addictive substances. Tobacco use contributes to leukemia, pneumonia and cancer of the pancreas, kidney, cervix, and stomach. Nearly 25% of adults in the United States use tobacco, and of these, 75% express interest in quitting. First line therapies have had limited long-term success for smoking cessation, even when combined with behavioral therapy. Recent discovery of a new endogenous signaling system, the endocannabinoid system, has brought the new drug Rimonabant to the forefront, not only as a promising smoking cessation adjuvant, but also as one to prevent post-cessation weight gain. Overactivity of the endocannabinoid system has been associated with tobacco dependence and obesity. The endocannabinoid system has two cannabinoid receptors, Cannabinoid 1 (CB1) and Cannabinoid 2 (CB2). The CB1 receptors are located primarily in the brain and have effects on overall homeostasis, and more specifically, on tobacco addiction and food intake. Rimonabant was developed as a CB1 blocker working to inhibit overactivity, and subsequently, decrease tobacco dependence and weight gain.

Methods: A review of the STRATUS (Studies with Rimonabant and Tobacco Use) study, one of the largest smoking cessation trials ever conducted in the United States, shows statistically significant data to support the use of Rimonabant for smoking cessation. STRATUS is a double-blinded, placebo-controlled study conducted at 11 U.S. clinical sites, with over 700 smokers assigned to one of three groups: placebo, 5 mg. Rimonabant, or 20 mg. Rimonabant for a period of 10 weeks.

Results: Initial positive results have been shown with Rimonabant in both smoking cessation and weight control in the United States and Europe. STRATUS-US has found that Rimonabant doubles the odds of quitting smoking compared to placebo, with fairly minimal side effects. A current worldwide study is now underway involving more than 4000 participants. 

Conclusion:  Rimonabant holds promise as a cannabinoid blocker and subsequent weight control medication. With an international trial currently in progress, Rimonabant is closer to becoming the next smoking cessation prescription. With current limited successful resources for smokers, Rimonabant's actions on the endocannabinoid system provide hope for tobacco users desiring cessation but fearing weight gain.


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