Rate of Nicotine Metabolism and Smoking Cessation Outcomes in a Community-based Sample of Treatment-Seeking Smokers

Amanda Kaufmann, Brian Hitsman, Patricia M. Goelz, Anna Veluz-Wilkins, Sonja Blazekovic, Lindsay Powers, Frank T. Leone, Peter Gariti, Rachel F. Tyndale, Robert A. Schnoll*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Background: In samples from controlled randomized clinical trials, a smoker's rate of nicotine metabolism, measured by the 3-hydroxycotinine to cotinine ratio (NMR), predicts response to transdermal nicotine. Replication of this relationship in community-based samples of treatment-seeking smokers may help guide the implementation of the NMR for personalized treatment for nicotine dependence. Methods: Data from a community-based sample of treatment seeking smokers (N. =. 499) who received 8. weeks of transdermal nicotine and 4 behavioral counseling sessions were used to evaluate associations between the NMR and smoking cessation. Secondary outcomes included withdrawal and craving, depression and anxiety, side effects, and treatment adherence. Results: The NMR was a significant predictor of abstinence (OR. =. .56, 95% CI: 0.33-0.95, p=. .03), with faster metabolizers showing lower quit rates than slower metabolizers (24% vs. 33%). Faster nicotine metabolizers exhibited significantly higher levels of anxiety symptoms over time during treatment, vs. slower metabolizers (NMR x Time interaction: F[3,357]. =. 3.29, p=. .02). NMR was not associated with changes in withdrawal, craving, depression, side effects, and treatment adherence (. p's. >. .05). Conclusions: In a community-based sample of treatment-seeking smokers, faster nicotine metabolizers were significantly less likely to quit smoking and showed higher rates of anxiety symptoms during a smoking cessation treatment program, vs. slower nicotine metabolizers. These results provide further evidence that transdermal nicotine is less effective for faster nicotine metabolizers and suggest the need to address cessation-induced anxiety symptoms among these smokers to increase the chances for successful smoking cessation.

Original languageEnglish (US)
Pages (from-to)93-99
Number of pages7
JournalAddictive Behaviors
StatePublished - Dec 1 2015


  • Anxiety
  • Biomarker
  • Nicotine dependence
  • Nicotine metabolite ratio
  • Pharmacogenetics
  • Smoking cessation

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Toxicology
  • Psychiatry and Mental health


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