Yet another study finds combination pharmacotherapy gives higher quit rates.

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I’ve discussed on numerous occasions on this blog the evidence that combining certain smoking cessation medicines consistently gets higher quit rates. In the past week another large study was published by the research group at University of Wisconsin , led on this occasion by Dr Stevens Smith.

One interesting aspect of this study was that it was conducted in real primary care clinics, in which they attempted to recruit all eligible smokers (of at least 10 cigarettes per day) to the trial. In the study, 1346 out of 7128 smokers (19%) entered the trial and were randomly allocated to treatment with either bupropion, the nicotine patch, the nicotine lozenge, bupropion plus lozenge, or patch plus lozenge. All patients were also offered counseling via a telephone quitline.

Six months later, the quit rates (no smoking in the previous 7 days) were as follows:
Patch: 18%
Lozenge: 20%
Bupropion: 17%
Patch plus lozenge: 27%
Bupropion plus lozenge: 30%

These results are very consistent with the results from another recent study by the same group, which also found that combination pharmacotherapy produced higher quit rates than a single medicine, and are also consistent with the bulk of research on this issue. The main difference was that the previous study found that the highest quit rates were obtained by combining the patch and the lozenge.

Of the medicines included in this study, bupropion is a prescription-only medicine and not appropriate for people who are at increased risk of a seizure, and the others are nicotine replacement therapies available over the pharmacy counter. The message from this and other studies seems to be that it is advantageous to combine a slow-acting medicine (like bupropion or the patch) with a faster acting NRT product (like the nicotine gum, lozenge, inhaler or nasal spray). As previously discussed, it is not yet recommended that patients combine NRT with varenicline, as this has not yet been shown to be safe and effective.

So the conclusion here is that combination NRT or bupropion plus NRT is the way to go to improve your chances of quitting smoking if you smoke at least 10 cigarettes per day and don't have any contraindications to using these medicines.
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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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