Background:
Current smoking cessation methods are primarily based on the theory that nicotine is the principal addicting compound overlooking the contribution of the monoamine oxidase inhibitors present in tobacco. Our study tests the hypothesis that the MAOI phenelzine can successfully mimic and replace the MAOI effects of tobacco's harmala alkaloids and aid in the reduction and cessation of tobacco use.

Methods:
Current smokers were treated with the MAOI phenelzine. All patients were given information regarding the risk of interactions between MAOIs and other medications and certain tyramine-containing foods. Those who had previously been treated with SSRIs, pain medications or other potentially reactive medications were told to stop taking those medications for a wash-out period of 2 weeks prior to starting the MAOI. The patients were titrated up from an initial dose of approximately 1.875mg (one-eighth of a 15mg tablet) every 2 hours to a maximum of 15mg TID.

Results:
Both of the patients described here had failed previous treatment with NRTs (nicotine gum, nicotine lozenges, and nicotine transdermal patches). Following treatment with phenelzine each demonstrated a significant improvement in scoring on the Fagerstrom Test for Nicotine Dependence (FTND) and the Quality of Life and Satisfaction Questionnaire- Short form (Q-LES-Q-SF).

Conclusions:
These preliminary findings, which have been duplicated in approximately 35% subjects treated with phenelzine, suggest a potent new treatment for tobacco addiction. We are currently collecting more data on smokers receiving phenelzine to fortify our argument that tobacco addiction is about more than nicotine dependence. Multiple components in tobacco, their combustion products, and their metabolized by-products may contribute to tobacco addiction. Phenelzine, a non-selective monoamine oxidase inhibitor, appears be useful in the treatment of tobacco addiction, a scourge which kills or cripples millions of people throughout the world as well as drains financial resources from those chained to this highly addictive compound.