Information for Healthcare Professionals
Supporting smoking cessation with Acetium Lozenge
Tobacco smoking is one of the biggest risk factors for lung and upper gastrointestinal tract cancers. According to the Office for National Statistics, the number of smokers in Britain has more than halved in the last 40 years. Despite this, smoking remains the leading cause of preventable death.
Combustion of tobacco releases high concentrations of toxic aldehydes, the most abundant of which is acetaldehyde. Acetaldehyde is a known mutagen and carcinogen that is easily dissolved in saliva during smoking allowing its distribution through the oral cavity and upper digestive tract.
Acetium Lozenge contains L-cysteine, a non-essential amino acid that has been shown to bind acetaldehde from salva during smoking which can reduce the carcinogenic potential of smoking.
Tobacco derived Acetaldehyde in saliva is mutagenic
The International Agency for Research on Cancer (IARC) categorises acetaldehyde as a Group 1 carcinogen. During smoking the average acetaldehyde content in saliva is approximately 228 micromoles per litre. The mutagenic level of acetaldehyde is defined as above 50-100 micromoles. Thus, during smoking salivary acetaldehyde concentration exceeds the risk tolerance by 2-4 times.
Evidence shows that Acetaldehyde increases smoking dependance
Studies in animals have shown that acetaldehyde reinforces dependency on nicotine. Salivary acetaldehyde binds with biogenic amines (e.g. tryptamine, serotonin) forming harman compounds. Blood Harmane, an inhibitor of mono-amine oxidase (MAO) increases 10 fold during smoking, exerting an anti-depressant effect and increasing the pleasure associated with smoking.
Acetium Lozenge could alleviate acetaldehyde-enhanced nicotine adiction
Acetium Lozenge removes over 90% of acetaldehyde dissolved in saliva during smoking blocking the formation of harmans, which could alleviate acetaldehyde-enhanced nicotine addiction among smokers.
Acetium smoking intervention
The effective removal of acetaldehyde from saliva by L-cysteine was demonstrated as early as 2002 when Professor Mikko Salaspuro of the Research Unit of Substance Abuse Medicine at the Helsinki University Central Hospital explored how effective this non-essential amino acid was at eliminating ethanol-derived acetaldehyde with a slow-release buccal tablet. Their positive findings spurred Salaspuro's interest in in vivo acetaldehyde which led the researchers to explore the synergystic effect of alcohol consumption and smoking on the concentration of acetaldehyde in saliva too, publishing their findings in 2004.
These earlier clinical trials demonstrated that acetaldehyde was a common and cumulitive carcinogen. Combining the new found knowledge of how to effectively remove acetaldehyde from saliva, with the evidence about the possible link between acetaldehyde and nicotine dependence from animal studies, meant that for the first time a robust clinical trial could be formulated to test the efficacy of L-cysteine as a new smoking cessation intervention.
A randomised, double blind placebo-controlled trial was published in 2017 demonstrating the efficacy of Acettium in smoking cessation with the following summary findings:
The mean time to quit smoking was 102 days and 104 days in the Acetium and placebo arms (p=0.835) respectively
During intervention, 331 smokers quit smoking (16.6%)
Of those who quit, 181 (18.2%) were in the Acetium arm and 150 (15.0%) in the placebo arm (p=0.008; for all outcomes)
In the Per Protocol group 45.3% (170/375) quit smoking in the Acetium arm and 35.4% (134/378) in the placebo arm
The odds ratio to quit in the Acetium vs. placebo arms was OR=1.51 (95%CI 1.12-2.02)(p=0.006), i.e. 51% more in Acetium vs. Placebo.
Quit smoking without nicotine
Acetium lozenges contain L-cysteine, which is a natural amino acid that is found in the diet. L-cysteine effectively binds acetaldehyde from saliva and forms a harmless compound that can be excreted from the body.
L-cysteine in Acetium releases slowly in the mouth to remove over 90 percent of the acetaldehyde dissolved into saliva during smoking.
By choosing Acetium Lozenge to help you quit smoking you are choosing a Nicotine-free option. Acetium does not contain nicotine and therefore tackles your nicotine dependence head on.
The recommended dosage is 1 or 2 lozenges during smoking.
*Acetium lozenges do not reduce other adverse effects of smoking, nor do they remove carcinogens other than acetaldehyde. Stopping smoking is recommended due to all its adverse effects.
How effective is Acetium?
Clinical trials have shown that regular use of the Acetium lozenge during smoking increases the likelihood of quitting by a factor of 1.5 compared to a placebo (1, 2).
Acetium lozenges contain L-cysteine, a natural amino acid that efficiently binds acetaldehyde dissolved in saliva from cigarette smoke and converts it into a harmless compound (3).
In the above study(3) the effect of slow-release L-cysteine lozenge on salivary acetaldehyde was examined during smoking. The volunteers smoked one cigarette and all the saliva for that time period was collected and its acetaldehyde concentration was determined. As shown on the slide 1.25 mg of L-cysteine in the tablet eliminated over 50% of acetaldehyde from the saliva. With 2.5mg of L-cysteine in the tablet over 90 % of salivary acetaldehyde was eliminated.
What is acetaldehyde?
Acetaldehyde is a carcinogen (3) and one of the harmful substances in tobacco smoke. Normal saliva does not contain acetaldehyde (4).
The Acetium lozenge removes up to 90% of smoke-derived acetaldehyde in saliva.
Innovation from Finland
Developed and manufactured in Finland, the Acetium lozenge is free from the side effects of conventional smoking cessation methods, such as nicotine dependency or possible adverse effects of medication.
The active substance of lozenge is slow dissolving L-cysteine (3 mg/tablet). Other ingredients: xylitol (250 mg/tablet) (E967), sorbitol (224 mg/tablet) (E420), smoke flavor, anise flavor, magnesium stearate (E470b), silicon dioxide (E551). Tablet weight 500 mg. Does not contain lactose, gluten or nicotine.
How does Acetium work?
When you smoke a cigarette, a significant amount of acetaldehyde is absorbed into your saliva from the tobacco smoke. The slowly released L-cysteine contained in the Acetium lozenge is very effective in binding this acetaldehyde in saliva. Using Acetium lozenge during smoking changes the taste of cigarettes and reduces the pleasure of smoking, making it easier for you to give up.
How long should Acetium be used for? Is there a limit?
Acetium lozenges are designed to be taken whenever smoking, in other words the lozenge is kept in your mouth for the entire time you are smoking. If required, you can take a second lozenge during the same cigarette. Once you have stopped smoking, the lozenges are no longer necessary as the effect is only present when they are taken while smoking. On average, the smokers who took part in the trial were able to quit within 3-4 months, while some required up to 6 months. For this reason, we recommend that the lozenges are used for a period of at least 6 months to achieve the desired effect.
How quickly can people expect to quit smoking with Acetium?
In two separate trials, the average time to quit smoking using Acetium lozenges was slightly over 100 days. For some smokers, the effect was achieved sooner (in a few weeks), while others required 6 months of use. This is reflective of differences in the way individuals react to the effects of Acetium lozenges, and is the reason why no single time frame for achieving the effect can be determined.
How many Acetium lozenges can be taken daily?
Despite the fact that there is no upper limit to the daily intake of Acetium lozenges in terms of its active ingredient, a daily upper limit of 40 lozenges has been determined. This is equivalent to smoking two packs of cigarettes. The daily upper limit has been set mainly due to the laxative effects that many begin to experience after this dose is exceeded (increased frequency of defecation, diarrhoea). These side effects are caused by and are typical of the xylitol contained in the lozenge. The active ingredient in the lozenge (slowly released L-cysteine) is so low in concentration that it has no significance in determining the daily intake limit.
Can Acetium be used by people under 18 years of age?
There is no practical restriction to this. However, as our trials were only included adult participants, we have not clinically studied the effectiveness and effects of the product on young persons.
Are there any side effects to Acetium lozenges?
The concentration of the active ingredient in the lozenges is so low that it has no side effects. However, as the lozenges contain a small amount of xylitol, excess daily intake (over 40 pcs) of the lozenges may result in laxative effects in some people. There are no other reported side effects.
What is the active ingredient in Acetium?
The active ingredient in the lozenges is slowly released L-cysteine. Studies have shown that acetaldehyde absorbed in saliva from tobacco smoke can be removed almost entirely with a very low dosage of L-cysteine.
How much has the product been tested?
The product has gone through extensive testing. Its effectiveness in eliminating acetaldehyde from saliva has been demonstrated in several clinical trials. The suitable dosage for the active ingredient has also been tested in these trials. The effectiveness of the lozenge as an aid in quitting smoking is based on two independent clinical trials that produced almost consistent findings. Similarly, the findings on the mechanism by which the product is effective were consistent. Both found that the lozenge changes the taste of cigarettes and reduces the pleasure of smoking.
Does the Acetium lozenge contain allergens?
As with all products manufactured in tablet form, Acetium lozenges contain certain excipients necessary to disperse the active ingredient as a slowly released lozenge. These excipients are used commonly in many similar medications and equivalent products. An allergic reaction to such substances is rare but not impossible. If you know of any allergies to the substances used as excipients in the lozenges, you should refrain from using the product.
Will Acetium help for smoking whilst drinking alcohol?
Drinking alcohol can also increase levels of acetaldehyde in saliva, however the lozenges are effective regardless of whether the source of acetaldehyde is cigarettes or alcohol. The topic as such has not been studied, but there is no discernible reason for the lozenges not to be effective also in this case. It is logical to presume that use of the lozenges should be increased in dosage and/or frequency when consuming alcohol and cigarettes simultaneously. In such cases, it would be helpful to also take lozenges between cigarettes in order to achieve a more balanced effect on the overall acetaldehyde concentration in saliva, in comparison with only taking the lozenges while smoking.
Can Acetium be used to stop vaping with eCigs?
Although acetaldehyde is found in the vapour of e-cigarettes no studies of Acetium's effectiveness for quitting e-cigarettes have been carried out, and therefore we cannot recommend the use of the lozenges to quit e-cigs.
Syrjänen K et al. Elimination of cigarette smoke-derived acetaldehyde in saliva by slow-release L-cysteine lozenge is an effective new method to assist smoking cessation. A randomised, double-blind, placebo-controlled intervention. Anticancer Res. 2016;36:2297-2306.
Syrjänen K et al. Slow-release L-cysteine (Acetium) lozenge is an effective new method in smoking cessation. A randomized, double-blind, placebo-controlled intervention. Anticancer Res 2017;37:3639-3648.
Secretan B et al. WHO International Agency for Research on Cancer Monograph Working Group. A review of human carcinogens- Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol 10:1033-1034.