In addition to significantly affecting smoking behavior, nicotine clearance rate has been shown to contribute to the efficacy of cessation pharmacotherapy in various retrospective studies [19–21]. In a recent randomized prospectively NMR-stratified placebo-controlled clinical trial, varenicline (a prescription medication for smoking cessation) was more efficacious for normal metabolizers compared to nicotine patch [22]. Nicotine patch was equally effective in slow metabolizers with less side-effects than in varenicline treatment, suggesting that tailored pharmacotherapy, i.e. stratifying on NMR level, can be one approach for improving smoking cessation rates [22]. This first clinical trial to take nicotine metabolism rate into account is a landmark paper highlighting the importance of the metabolic component cigarette smoking and use of other nicotine products.
