Is bupropion (Bupropion) more effective than varenicline (Varenicline) for smoking cessation?

From the Guidelines

Varenicline is generally considered more effective than bupropion for smoking cessation. According to a 2016 study published in the Journal of the National Comprehensive Cancer Network, varenicline increases the odds of smoking cessation by almost 3-fold compared with placebo (OR, 2.88; 95% CI, 2.40–3.47) 1. This study also found that varenicline was more efficacious than bupropion (OR, 1.59; 95% CI, 1.29–1.96) and single forms of NRT.

Some key points to consider when choosing between varenicline and bupropion include:

• Varenicline works by partially stimulating nicotine receptors to reduce withdrawal symptoms and blocking these receptors to decrease the pleasure from smoking.
• Bupropion, originally an antidepressant, helps reduce cravings and withdrawal symptoms by affecting dopamine and norepinephrine levels in the brain.
• For optimal results, varenicline (Chantix) is usually taken at 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.
• Bupropion (Zyban) is typically prescribed at 150 mg once daily for 3 days, then 150 mg twice daily for 7-12 weeks.
• Both medications should be started 1-2 weeks before the quit date.
• Side effects differ between the medications: varenicline commonly causes nausea, vivid dreams, and sleep disturbances, while bupropion may cause insomnia, dry mouth, and carries a small risk of seizures.

It's also worth noting that individual responses to these medications can vary, and some patients may respond better to bupropion, particularly those with depression. The choice between these medications should consider the patient's medical history, previous quit attempts, and potential side effects. A 2015 study published in the Annals of Internal Medicine found that a pooled estimate of four studies evaluating bupropion SR versus varenicline found a lower cessation rate with bupropion SR than varenicline (RR, 0.68 [CI, 0.56 to 0.83]) 1.

From the Research

Comparison of Bupropion and Varenicline for Smoking Cessation

• Bupropion and varenicline are two prominent medications used for smoking cessation, but their effectiveness can vary 2, 3, 4, 5, 6.
• Studies have shown that varenicline tends to have a higher cessation rate compared to bupropion at both 3 and 12 months 2, 3, 4.
• A randomized controlled trial found that varenicline had a higher continuous abstinence rate from smoking during the last 4 weeks of treatment (43.9%) compared to bupropion (29.8%) and placebo (17.6%) 3.
• Another study found that varenicline demonstrated both short-term and long-term efficacy for smoking cessation, with a continuous quit rate of 48.0% at 4 weeks and 14.4% at 52 weeks, compared to bupropion (33.3% at 4 weeks and 6.3% at 52 weeks) and placebo (17.1% at 4 weeks and 4.9% at 52 weeks) 4.

Efficacy and Safety of Varenicline

• Varenicline has been shown to be generally well-tolerated, with the most common adverse event being nausea 3, 4, 5, 6.
• Varenicline has been found to have a superior efficacy compared to bupropion and placebo for achieving abstinence from smoking, and has also been shown to significantly delay smoking relapse 3, 4, 5, 6.
• The mechanism of action of varenicline, as a partial agonist at the alpha4beta2 nicotinic acetylcholine receptor, allows it to attenuate craving and withdrawal symptoms, and reduce the rewarding effects of nicotine 5, 6.

Key Findings

• Varenicline tends to have a higher cessation rate compared to bupropion at both 3 and 12 months 2, 3, 4.
• Varenicline has been found to be generally well-tolerated, with a superior efficacy compared to bupropion and placebo for achieving abstinence from smoking 3, 4, 5, 6.