Although alcohol-dependent smokers represent an important group for applying smoking interventions, sufficient pharmacotherapy has not been established in this high-risk group so far. Acetylcholinesterase-inhibitors inhibit the breakdown of Ach. The retention time of this neurotransmitter is prolonged and thereby the efficiency of cholinergic neurotransmission at nAChRs is enhanced. Thus, we suppose a possible substitution of neuronal nicotine effects.

In order to examine the effect of acetylcholinesterase-inhibitors on tobacco dependence, we performed clinical-pharmacological studies on alcohol and tobacco dependent patients who had already completed an alcohol detox. We investigated galantamine (with positive allosteric modulation, n=114, randomized placebo controlled over 24 weeks) and rivastigmine (without allosteric modulation, n=26, randomized, placebo controlled over 12 weeks) and assesses smoking behavior (diaries, FTND, CO measurements) as well as craving for tobacco (QSU) and alcohol (AUQ).

Galantamine (Diehl et al., 2006) as well as rivastigmine (Diehl et al., 2008) led to a significant smoking reduction (galantamine: -20% after 24 weeks, rivastigmine: -30% after 12 weeks) without compromising the alcohol abstinence. Patients taking rivastigmine also experienced a significant reduction of nicotine craving (-20%), without any other specific pharmacological or psychotherapeutical action to support the smoking cessation.

Our preliminary data indicate an effect of galantamine and rivastigmine on tobacco craving and consumption in alcohol dependent smokers. These pilot studies encourage further investigation of acetylcholinesterase-inhibitors as a promising treatment approach regarding tobacco dependence.