Varenicline and Nicotine Replacement Together Are Better Than Varenicline Alone

Thomas L. Schwenk, MD

This seemingly illogical combination was reasonably effective for smoking cessation in adult long-term smokers.

Varenicline supports smoking cessation by acting as both a nicotine antagonist and a partial agonist; both actions might neutralize the benefit of nicotine-replacement therapy. In the few published studies of combined therapy, no significant benefit was reported. To investigate further whether combination therapy might be effective, researchers in South Africa randomized 446 adult long-term smokers (mean age, 46; mean pack-years of smoking, 21) to 12 weeks of varenicline (Chantix; titrated to 1 mg twice daily) plus nicotine replacement patches (15 mg, worn for 16 hours daily) or to varenicline plus placebo patches. People with chronic medical and psychiatric illnesses were excluded.

The 4-week continuous abstinence rates (during weeks 9–12, measured by exhaled carbon monoxide) were 55% for combination-therapy participants versus 40% for varenicline-monotherapy participants. The corresponding 24-week abstinence rates were 49% and 33%. Six to seven people would need to be treated at either assessment point for one person to benefit. Weight gain and mild adverse events occurred with similar frequency in both groups.

Citation(s):

Koegelenberg CFN et al. Efficacy of varenicline combined with nicotine replacement therapy vs varenicline alone for smoking cessation: A randomized clinical trial. JAMA 2014 Jul 9; 312:155.