From the Guidelines
Semaglutide is not recommended as a primary treatment option for tobacco cessation due to the lack of robust clinical trials specifically examining its efficacy for this purpose. Current evidence suggests that GLP-1 receptor agonists like semaglutide might reduce nicotine cravings and withdrawal symptoms by affecting reward pathways in the brain that are involved in addiction 1. Some preliminary studies have shown that people taking semaglutide for weight loss or diabetes management have spontaneously reported reduced desire to smoke. The medication works by mimicking the hormone GLP-1, which not only regulates blood sugar and appetite but also appears to influence dopamine signaling in the brain's reward system.
Key Points to Consider
- The most effective strategies for smoking cessation include brief interventions with advice to stop smoking, all types of nicotine replacement therapy (NRT), bupropion, and varenicline, with the most effective being brief interventions plus assistance with stopping using drug therapy and follow-up support 1.
- Electronic cigarettes (e-cigarettes) may help in smoking cessation but should be covered by the same marketing restrictions as cigarettes 1.
- The USPSTF found convincing evidence that pharmacotherapy interventions, including nicotine replacement therapy (NRT), bupropion hydrochloride sustained-release (bupropion SR), and varenicline—with or without behavioral counseling interventions—substantially improve achievement of tobacco cessation in nonpregnant adults who smoke 1.
- Common side effects of semaglutide include nausea, vomiting, diarrhea, and constipation, and while promising, more robust clinical trials specifically examining semaglutide for smoking cessation are needed before it can be recommended as a primary treatment option for quitting smoking.
Recommendations for Clinicians
- If considering semaglutide for smoking cessation, patients should discuss this off-label use with their healthcare provider, as typical doses would be similar to those used for weight management (starting at 0.25mg weekly, gradually increasing to 2.4mg) 1.
- Clinicians should prioritize evidence-based treatments for smoking cessation, including NRT, bupropion, and varenicline, and consider combination therapy for optimal results 1.
From the Research
Semaglutide and Tobacco Cessation
- Semaglutide, a glucagon-like peptide-1 receptor agonist, has shown potential in aiding tobacco cessation, particularly in individuals with type 2 diabetes mellitus 2, 3.
- Studies have found that semaglutide use is associated with a significantly lower risk for medical encounters for tobacco use disorder diagnosis, reduced smoking cessation medication prescriptions, and counseling 2, 3.
- The association between semaglutide and tobacco use disorder was strongest compared to insulins and weakest but statistically significant compared to other glucagon-like peptide-1 receptor agonists 3.
- The differences in tobacco use disorder-related health care measures occurred primarily within 30 days of semaglutide prescription initiation 3.
Mechanism of Action and Potential Benefits
- Semaglutide has been shown to improve glycemic control, promote weight loss, and reduce cardiovascular risks associated with diabetes mellitus 4, 5.
- Its potential benefits also extend to treating polycystic ovary syndrome and Alzheimer's disease due to its anti-neuroinflammatory effects 4.
- However, semaglutide therapy is also associated with concerning adverse effects, such as acute pancreatitis, anesthetic risks, and diabetic retinopathy 4.
Comparison to Other Studies
- A systematic review of combination bupropion SR and varenicline for smoking cessation found that combination therapy yielded greater efficacy than varenicline monotherapy 6.
- However, this study did not investigate the use of semaglutide for tobacco cessation, and its findings are not directly relevant to the question of semaglutide's effectiveness in aiding tobacco cessation.