Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics
Open accessAbstract
Nicotine sustains tobacco addiction, a major cause of disability and premature death. Nicotine binds to nicotinic cholinergic receptors, facilitating neurotransmitter release and thereby mediating the complex actions of nicotine in tobacco users. Dopamine, glutamate, and gamma aminobutyric acid release are particularly important in the development of nicotine dependence, and corticotropin-releasing factor appears to contribute to nicotine withdrawal. Nicotine dependence is highly heritable. Genetic studies indicate roles for nicotinic receptor subtypes, as well as genes involved in neuroplasticity and learning, in development of dependence. Nicotine is primarily metabolized by CYP 2A6, and variability in rate of metabolism contributes to vulnerability to tobacco dependence, response to smoking cessation treatment, and lung cancer risk. Tobacco addiction is much more common in persons with mental illness and substance abuse disorders, representing a high proportion of current smokers. Pharmacotherapeutic approaches to tobacco addiction include nicotine replacement, bupropion, and varenicline, the latter a selective nicotine receptor partial agonist.
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Gestational nicotine exposure causes alterations to development in regions such as the PFC, VTA, NA, and caudate and may contribute towards the development of ADHD, schizophrenia, anxiety, obesity, and future adolescent substance abuse.
“Moreover, clinical, and preclinical research has demonstrated that gestational nicotine exposure causes alterations to development in regions such as the PFC, VTA, NA, and caudate and may contribute towards the development of ADHD, schizophrenia, anxiety, obesity, and future adolescent substance abuse [17].”
From Prenatal nicotine exposure during pregnancy results in adverse neurodevelopmental alterations and neurobehavioral deficits (2023) · cites this paper as [17]
The ‘Pharmacodynamics of Nicotine: Contributions to Smoking-Related Disease’ section (page not supplied) identifies fetal neuroteratogenic effects as a suspected adverse effect of nicotine, supporting a general concern about prenatal brain development. It does not establish developmental alterations in the named brain regions or link gestational exposure to the listed conditions and later substance abuse. The ‘Neuropharmacology’ section names some of those regions, but describes acute nicotine effects rather than gestational development. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe pharmacokinetic profile of nicotine during cigarette smoking is a rapid rise and fall in plasma nicotine concentrations.
“The pharmacokinetic profile of nicotine during cigarette smoking is a rapid rise and fall in plasma nicotine concentrations [5].”
From A Randomised Study to Investigate the Nicotine Pharmacokinetics of Oral Nicotine Pouches and a Combustible Cigarette (2022) · cites this paper as [5]
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- Authors
- Benowitz, N. L.
- Affiliations
- San Francisco General Hospital (US)
- Corresponding author
- Benowitz, Neal L.
- ORCID
- Benowitz, Neal L.
- Venue
- Annual Review of Pharmacology and Toxicology
- Publisher
- Annual Reviews
- Published
- 2009-02-01
- Volume
- 49
- Issue
- 1
- Pages
- 57-71
- ISSN
- 0362-1642 (ISSN-L)
- 1545-4304
- PMC
- PMC2946180
- OpenAlex
- W2137599927
- Cited by
- 979
- References
- 90
- Citations by year
- 2026: 75 · 2025: 89 · 2024: 91 · 2023: 89 · 2022: 72 · 2021: 70 · 2020: 60 · 2019: 56 · 2018: 42 · 2017: 55 · 2016: 37 · 2015: 42 · 2014: 43 · 2013: 39 · 2012: 35
- FWCI
- 2.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Annual Review of Pharmacology and Toxicology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Public Health Service
- National Institute on Drug Abuse (DA20830, DA02277, R01DA002277, U01DA020830, R37DA002277)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- nicotine, tobacco dependence, nicotine dependence, nicotinic acetylcholine receptors, nicotine withdrawal, dopamine release, glutamate release, GABA release, corticotropin-releasing factor, genetic susceptibility, CYP2A6, nicotine metabolism, lung cancer risk, smoking cessation, mental illness, substance abuse, nicotine replacement therapy, bupropion, varenicline, partial agonists
- MeSH terms
- Varenicline, Animals, Benzazepines, Nonprescription Drugs, Ganglionic Stimulants, Humans, Nicotine, Quinoxalines, Smoking, Tobacco Use Disorder, Bupropion, Behavior, Addictive, Nicotinic Agonists
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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