New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What has been Investigated and What is in the Pipeline? Emma Beard1,2, Lion Shahab1, Damian M. Cummings3, Susan Michie2 & Robert West1 1 University College London, Department of Epidemiology and Public Health, London, UK 2 University College London, Department of Clinical, Educational and Health Psychology, London, UK 3 University college London, Department of Neuroscience, Physiology & Pharmacology, London, UK Running header: New Agents for smoking cessation and tobacco harm reduction Word count: 12,739 Journal: Invited by CNS drugs Correspondence: Emma Beard, Cancer Research UK Health Behaviour Research Centre, University College London, WC1E 6BP, UK. Email:
[email protected]. Tel: 0203 108 3179 Abstract A wide range of support is available to help smokers to quit and aid attempts at harm reduction, including three first-line smoking cessation medications: nicotine replacement therapy, varenicline and bupropion. Despite the efficacy of these, there is a continual need to diversify the range of medications so that the needs of tobacco users are met. This paper compares the first-line smoking cessation medications to: 1) two variants of these existing products: new galenic formulations of varenicline and novel nicotine delivery devices; and 2) twenty-four alternative products: cytisine (novel outside of central and eastern Europe), nortriptyline, other tricyclic antidepressants, electronic cigarettes, clonidine (an anxiolytic), other anxiolytics (e.g. buspirone), selective 5-hydroxytryptamine (5-HT) reuptake inhibitors, supplements (e.g. St John’s wort), silver acetate, nicobrevin, modafinil, venlafaxine, monoamine oxidase inhibitors (MAOI), opioid antagonist, nicotinic acetylcholine receptors (nAChR) antagonists, glucose tablets, selective cannabinoid type 1 receptor antagonists, nicotine vaccines, drugs that affect gamma-aminobutyric acid (GABA) transmission, drugs that affect N-methyl-D-aspartate receptors (NMDA), dopamine agonists (e.g.