Dr Hilary Tindle Discusses Use of the Nicotine Metabolite Ratio in Clinical Care

Hilary Tindle, MD, MPH, associate professor of medicine, at Vanderbilt University, discusses how the nicotine metabolite ratio (NMR) can help inform doctors and patients on choosing the optimal treatment for quitting smoking.

Although not a standard of care, the nicotine metabolite ratio (NMR) helps doctors and patients in a clinical care setting jointly make a decision on the best treatment approaches for quitting smoking for that individual, noted Hilary Tindle, MD, MPH, associate professor of medicine, at Vanderbilt University.


How can the NMR best be implemented into clinical care for nicotine and smoking treatments?

The NMR, or nicotine metabolite ratio, is not currently standard of care. Right now, if a patient comes into the doctor's office and wants to quit smoking or is goaded into quitting smoking, guilted into it by the provider, is motivated to quit, we don't typically use the nicotine metabolite ratio. It's just a conversation with a patient, sometimes their family, about all the options. So, nicotine replacement, varenicline, bupropion is another prescription medicine that is FDA approved for quitting. And then based on that conversation, the patient and the health care provider jointly make a decision [on] what's the best medicine.

The nicotine metabolite ratio is a precision approach that could actually inform what's the best medicine. Is it going to be varenicline? The faster metabolizers, people whose livers break down nicotine faster, tend to do better with varenicline; they quit twice as often on varenicline, also called Chantix, compared to the nicotine patch. So that's just one way that precision medicine can actually be folded into the current process of clinical care. But it's not standard of care yet.

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