What is the comparison between Chantix (varenicline) and Wellbutrin (bupropion) for smoking cessation?

From the Guidelines

Chantix (varenicline) is the preferred medication for smoking cessation due to its higher success rates compared to Wellbutrin (bupropion), with a relative risk of 1.39 (95% CI, 1.25-1.54) favoring varenicline 1. When considering smoking cessation, both Chantix and Wellbutrin are effective options, but the choice between them should be based on their efficacy, side effect profiles, and patient-specific factors.

• Key differences between Chantix and Wellbutrin include their mechanisms of action: Chantix partially activates nicotine receptors while blocking nicotine from binding, reducing cravings and withdrawal symptoms, whereas Wellbutrin inhibits dopamine reuptake, also reducing nicotine cravings and withdrawal symptoms.
• The typical regimen for Chantix starts with 0.5 mg once daily for days 1-3, then 0.5 mg twice daily for days 4-7, followed by 1 mg twice daily for 12 weeks total, while Wellbutrin is started at 150 mg daily for 3 days, then 150 mg twice daily for 7-12 weeks, beginning 1-2 weeks before the quit date.
• Side effects and contraindications also vary: Chantix commonly causes nausea, vivid dreams, and sleep disturbances, and is contraindicated in pregnancy, requiring dose adjustment in kidney disease, while Wellbutrin may cause insomnia, dry mouth, and has a rare risk of seizures, making it unsuitable for patients with seizure disorders, eating disorders, or those taking MAOIs.
• Both medications significantly increase the chances of quitting compared to placebo, but the higher efficacy of Chantix, as shown in meta-analyses of randomized trials 1, makes it the preferred choice for smoking cessation, especially when combined with behavioral therapy, which can further increase quit rates.

From the FDA Drug Label

Study 4 and Study 5 These identical double-blind studies compared varenicline 2 mg per day, bupropion sustained-release (SR) 150 mg twice daily, and placebo. In Study 4, patients treated with varenicline had a superior rate of CO-confirmed abstinence during weeks 9 through 12 (44%) compared to patients treated with bupropion SR (30%) or placebo (17%).

The comparison between Chantix (varenicline) and Wellbutrin (bupropion) for smoking cessation shows that varenicline has a higher success rate of CO-confirmed abstinence during weeks 9 through 12, with 44% of patients achieving abstinence compared to 30% of patients treated with bupropion SR.

• Key points:
  • Varenicline: 44% success rate
  • Bupropion SR: 30% success rate
  • Placebo: 17% success rate 2

From the Research

Comparison of Chantix (Varenicline) and Wellbutrin (Bupropion) for Smoking Cessation

• Chantix (varenicline) and Wellbutrin (bupropion) are two medications used to aid in smoking cessation.
• Studies have shown that varenicline is more effective than bupropion in helping people quit smoking 3, 4, 5.
• Varenicline has been shown to have a higher continuous quit rate than bupropion, with a rate of 43.9% to 65.4% compared to bupropion's rate of 33.3% 3, 5.
• Varenicline has also been shown to reduce craving and the rewarding effects of smoking more than bupropion 6.
• Both medications have been shown to be generally well-tolerated, but varenicline has been associated with a higher incidence of nausea 3, 7, 5.
• Bupropion has been associated with a higher rate of discontinuation due to adverse events compared to varenicline 3.

Efficacy of Varenicline and Bupropion

• Varenicline has been shown to be effective in reducing nicotine withdrawal symptoms and craving 4, 6.
• Bupropion has also been shown to be effective in reducing nicotine withdrawal symptoms and craving, but to a lesser extent than varenicline 4, 6.
• Varenicline has been shown to be more effective than bupropion in reducing the rewarding effects of smoking 6.

Safety and Tolerability of Varenicline and Bupropion

• Both varenicline and bupropion have been shown to be generally well-tolerated, but with some adverse events 3, 7, 5.
• Varenicline has been associated with a higher incidence of nausea, while bupropion has been associated with a higher rate of discontinuation due to adverse events 3, 5.
• The safety and tolerability of varenicline and bupropion have been evaluated in several studies, with no major safety concerns identified 4, 7.