Smoking Cessation

In a recent comparison of five different medications for smoking cessation, a nicotine patch plus a nicotine lozenge appeared most effective at helping smokers quit, according to new research.

"Many smokers have successfully quit using a variety of smoking cessation pharmacotherapies, yet there is little direct evidence on the relative efficacies of these different pharmacotherapies," says Megan E. Piper from the University of Wisconsin.

Smokers will not have a strong empirical basis for selecting among them without such evidence. The same is true with the clinicians too. Piper and colleagues conducted a randomized clinical trial of smoking cessation therapies involving 1,504 adults.

All had smoked at least 10 cigarettes a day during the previous six months and were motivated to quit. Participants were randomly assigned to one of six treatment groups: nicotine lozenge alone, nicotine patch alone, bupropion alone, patch plus nicotine lozenge, bupropion plus nicotine lozenge or placebo, the website Science Daily reported.

Bupropion treatment began one week before a designated quit date and continued for eight weeks; all other treatments were taken for eight to 12 weeks after the quit date. All participants also received six individual counselling sessions. One week, eight weeks and six months after the quit date, smoking rates were assessed.

Comparison of different treatments were done at the six-month point. The individuals in the patch plus nicotine lozenge group were more successful in quitting than those taking the placebo. Smokers using a patch and nicotine lozenge were also more likely to have quit at seven days and also with other more positive outcomes, such as a longer period of time before relapsing. In addition, individuals in the patch plus nicotine lozenge group along with the patch alone were most effective at helping people achieve at least one day of abstinence from smoking, which is an important stepping stone to successful quitting.

Previous research has combined the patch with other nicotine replacement therapies, such as gum, nasal spray or an inhaler. "The present results suggest that the nicotine lozenge can also be effective as an adjuvant to the nicotine patch," the authors write. The important factor seems to be that an ad libitum, or as needed smoking cessation pharmacothery agent must be paired with the patch; Just using higher patch doses does not seem to augment outcomes to the same degree." Though effective with the patch, the lozenge did not appear to give any better result than placebo when used alone. The findings were published in the November issue of Archives of General Psychiatry.