Several different treatments are available to help people stop smoking, including antidepressant medications such as bupropion SR and nortriptyline, the partial nicotine agonist/antagonist varenicline, nicotine replacement therapies (NRT) like the nicotine patch, inhaler, spray, gum and lozenge, smoking cessation support groups and help lines. While treatment with one of these options (monotherapy) is effective, current research indicates that the most successful way to stop smoking is with combination therapy, combining two of these methods.
Combination Nicotine Replacement Therapies (NRT)
Using two different forms of nicotine replacement therapy (NRT) simultaneously may be the most successful way to stop smoking. This combination may be effective because it is possible to pair a long-acting NRT (like the patch) with a shorter-acting NRT that can be used as needed (lozenge, gum, nasal spray or inhaler). Results from a study published in the November 2009 issue of "General Archives of Psychiatry" indicate that combination treatment with a nicotine patch plus nicotine lozenge is more effective than NRT monotherapies, bupropion SR monotherapy and the combination of bupropion plus nicotine lozenge. In the study, only participants who received the patch plus lozenge showed significantly higher quit rates than the control group after six months.
Combination Bupropion SR plus Nicotine Replacement Therapy (NRT)
Bupropion SR (sustained-release) is a medication used to treat depression; however, it can help people to stop smoking even if they are not depressed (doctors are not entirely sure how it achieves this). While effective on its own in helping people quit and remain smoke-free, it may be successfully combined with nicotine replacement therapies (NRT). Because the two medications act on different parts of the brain, the combination has the potential to be more powerful. A few studies examining the effectiveness of bupropion SR plus the nicotine patch have shown six and twelve-month abstinence rates to be between 34 and 35 percent. In the 2009 study in "General Archives of Psychiatry" referenced above, the combination of bupropion SR and nicotine lozenge produced a greater short-term benefit (eight weeks after quitting) compared with placebo, but it did not outperform NRT combination therapy long-term. More research is needed on buproprion plus NRT combination treatments to draw more definitive conclusions.
Combination Bupropion SR and Varenicline
A March 2009-published study in "Nicotine and Tobacco Research" offers early evidence that combination therapy with bupropion SR and varenicline may be more effective in helping people stop smoking than monotherapies. Participants who smoked an average of 19.9 cigarettes for 30 years were enrolled in the clinical trial. They were given 1mg varenicline twice daily along with 150mg bupropion SR twice a day for seven days. At three months, 71 percent of participants were abstinent from smoking. At six months, 58 percent remained smoke-free.
References
- "Journal of the American Pharmacists Association;" Systematic Review and Meta-Analysis of Combination Therapy for Smoking Cessation; Sima D. Shah, et al.; September-October 2008.
- "Archives of General Psychiatry;" A Randomized Placebo-Controlled Clinical Trial of 5 Smoking Cessation Pharmacotherapies; M.E. Piper, et al.; November 2009.
- "Nicotine and Tobacco Research;" Varenicline and Bupropion Sustained-Release Combination Therapy for Smoking Cessation; J.O. Ebbert, et al.; March 2009.
