Other Indications

Individuals with major depression have a high frequency of cigarette smoking, and TD nicotine can produce short-term improvement in mood. The effects of nicotine patches (17.5 mg) on 12 nonmedicated outpatients with major depression were studied over 4 continuous days (129). Two patients dropped out of the study because of nausea and vomiting. There was significant improvement in depression after day 2 of TD nicotine and patients relapsed 3 or 4 days after the final nicotine dose. Although nicotine TDS produced short-term improvement of depression, with minor side effects, nicotine TD was not recommended for clinical use in depression because of the high health risks of nicotine. It was concluded that analogues might be developed that can improve depression without major risks.

The therapeutic response to nicotine TD was investigated in patients with Tou-rette's syndrome (130). Twenty patients (17 children and adolescents, 3 adults) were studied following application of two patches (2 X 7 mg/24 h). There was a broad range in individual response, but each patch application produced a significant reduction in the Yale Global Tic Severity Scale scores, for an average duration of approximately 1 -2 weeks. This suggested that TD nicotine could be an effective adjunct to neuroleptic therapy of Tourette's syndrome. Nicotine gum and nicotine TD were used to reduce motor and vocal tics of children (age 8 years or older; weight >25 kg), adolescents, and adults (131). Reduction of tics was seen during chewing of nicotine gum, but improvement lasted no longer than 1 h after chewing. With nicotine TD, motor and vocal tics were reduced 45% over baseline in 85% of 35 subjects within 30 min to 3 h after patch application. Relief of symptoms with a single 7-mg patch, left on the skin for 24 h, persisted for variable periods up to 120 days. Application of a second patch for 24 h when symptoms returned resulted in similar reduction in tic severity and frequency, which persisted an average of 13 ± 3 days.

Short-term nicotine injections have improved attentional performance in patients with Alzheimer's disease (AD), but little is known about prolonged effects of nicotine. A study evaluated clinical and neuropsychological effects of extended TD nicotine application in AD subjects over a 4-week period (132). Patients were treated with nicotine TD (Nicotrol) for 16 h/day at the following doses: 5 mg/day (week 1), 10 mg/day (weeks 2 and 3), and 5 mg/day (week 4). Nicotine significantly improved attentional performance, with a significant reduction in errors of omission, which continued throughout nicotine administration, and variability of reaction time for correct responses was also significantly reduced. Nicotine did not improve performance on other tests measuring motor and memory function.

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