Combining varenicline and bupropion

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I recently received the following comment on my April/15/2007 post:
Chantix: how does this new stop smoking medicine work? 4/15/07
http://www.healthline.com/blogs/smoking_cessation/2007/04/chantix-how-does-this-new-quit-smoking.html

“I have been searching the web and have wondered if anyone knows if you can take both wellbutrin and Chantix at the same time. I have tried Chantix before and I had many of the crazy adverse side effects. It was the one way that I actually stopped for more than a week. I relapsed after 1 year of being smoke free. I have to quit this stuff it is killing me! I am hoping that I can take both of the medications to offset the moodiness I experienced last time. Thanks for your help!”

This is actually a very good question. Varenicline (Chantix) partly works by blocking certain nicotine receptors in the brain. That mechanism makes us doubt the rationale for combining varenicline with nicotine replacement therapy (NT), as varenicline should also block the effects of the NRT. But bupropion, while possibly affecting nicotine receptors, is believed to work via additional mechanisms (e.g. slowing the reuptake of dopamine). So it makes sense to consider whether there may be an added effect of combining those medicines.

Fortunately, the first study of this kind of treatment was very recently published. The study was published in the journal, Nicotine & Tobacco Research” by Dr John Ebbert and colleagues at the Mayo Clinic, in Rochester MN. The treated 38 smokers with the usual dose of varenicline, plus the usual dose of bupropion (SR: sustained release) for 12 weeks. The study was “open label” meaning that there was no comparison or “placbo” treatment and everyone knew what treatment was being provided. All the smokers were also provided with behavioral therapy. After around 12 weeks of treatment, 71% were not smoking (confrmed by a low exhaled carbon-monoxide measure), and at 6 months (i.e. 3 months without any medication) 58% were not smoking.

The most common side effects were those that have already been reported with these medicines. For example, 26% reported sleep disturbance (common with bupropion) and 24% reported nausea (common with varenicline). No increase in depressive symptoms was observed, and no suicidal thoughts were reported. The authors concluded that combination therapy with varenicline and bupropion SR may be effective for increasing smoking abstinence rates above that observed with a single medicine.

Although this study was small, and it is likely that the participants were very highly motivated and received more intensive treatment than is typically available, I agree that these results are quite promising. It is extremely unusual for any smoking cessation study to report a 6-month quit rate above 50%. So this appears to suggest that there may be some additive effects from combining these two medicines that are each effective on their own.

So what should readers who are interested in such a combined treatment do? It is important to note that this is just the first relatively small study, and so overall there is very little experience with this combination. Many doctors may quite reasonably prefer not to take any chances by prescribing a combined treatment before its efficacy and safety have been adequately studied. If you are able to see a doctor who is experienced in using these medicines, and willing to prescribe them together, I would suggest that you remain in regular contact with that prescriber throughout your quit attempt. I would also suggest that you should access some regular behavioral support or counseling (as was provided to the study participants). Hopefully within a year or two we will have more information on the combined use of these two smoking cessation medicines.

Reference
Varenicline and bupropion sustained-release combination therapy for smoking cessation. Ebbert JO, Croghan IT, Sood A, Schroeder DR, Hays JT, Hurt RD.Nicotine Tob Res. 2009 Feb 25.
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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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