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Heavy Smokers, Smoking Cessation, and Clonidine

Jack L. Cox, MC
JAMA. 1988;260(11):1553. doi:10.1001/jama.1988.03410110060017.
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To the Editor.—  The article entitled "Heavy Smokers, Smoking Cessation, and Clonidine" by Glassman et al1 raised interesting questions about using a nonnicotine medication as an adjunct in smoking cessation. However, there were several points that could have been clarified to help with evaluating the trial.First, the authors mention eligibility criteria for the study, using a modified Fagerström2 tolerance scale to determine those individuals who were heavily nicotine dependent, but excluding smokers who had not cut down to 50% of baseline level. This inclusion criterion may have selected out those smokers who were the most nicotine dependent, simply because they were unable to tolerate the withdrawal period. Including these individuals may have influenced the outcome, positively or negatively. Comparing a numerical score from the Fagerström scale would clarify this.Second, although serum nicotine and cotinine levels were measured at the end of four week's of clonidine treatment,


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