Cannabinoid type 1 receptor antagonists assist smoking cessation

Clinical question: 
Are selective type 1 cannabinoid (CB1) receptor antagonists effective in assisting smoking cessation?
Bottom line: 
From the preliminary trial reports available, selective CB1 receptor antagonists (rimonabant 20 mg) may increase the odds of not smoking at one year approximately 1.5 fold. The evidence for their effectiveness in maintaining abstinence is inconclusive. Higher doses (20 mg versus 5 mg) may moderate weight gain in the long term.
Caveat: 
Adverse effects include nausea and upper respiratory tract infections; the risk of serious adverse effects is reported to be low. However, there is current concern over rates of depression and suicidal thoughts in people taking selective CB1 receptor antagonists for weight control.
Context: 
Long-term use of nicotine can upset the brain’s endocannabinoid system which controls food intake and energy balance. Selective CB1 receptor antagonists may help smokers quit by rebalancing the system, which then reduces nicotine and food cravings. Rimonabant is now on the market, and is available in two strengths, 20 mg and 5 mg.
Review CD#: 
CD005353
PEARLS No: 
62
Date: 
May, 2008
Authored by: 
Brian R McAvoy