From the Guidelines
Varenicline is the most effective single pharmacotherapy option for smoking cessation, with a success rate almost 3-fold higher than placebo.
Key Points
- Varenicline has been shown to be more efficacious than bupropion and single forms of nicotine replacement therapy (NRT) in promoting smoking cessation 1.
- The medication is typically taken for 12 weeks, with a dosing regimen that starts at 0.5mg once daily and increases to 1mg twice daily 1.
- Combining varenicline with behavioral support, such as counseling, can further improve quit rates 1.
- Other effective options for smoking cessation include NRT, bupropion, and combination therapy with multiple forms of NRT or NRT and bupropion 1.
Treatment Options
- Varenicline: 0.5mg once daily for days 1-3, then 0.5mg twice daily for days 4-7, and finally 1mg twice daily for the remainder of treatment 1.
- NRT: available in various forms, including patches, gum, lozenges, inhalers, and nasal sprays, with dosing regimens varying depending on the specific product and patient needs 1.
- Bupropion: 150mg daily for 3 days, then 150mg twice daily, particularly helpful for those concerned about weight gain 1.
Behavioral Support
- Counseling: can double success rates when combined with medication, and should include setting a specific quit date, identifying triggers, developing coping strategies, and seeking ongoing support 1.
- Telephone counseling: effective in improving quit rates, with at least 3 telephone calls recommended 1.
- Self-help materials: tailored print-based materials can be effective in improving smoking abstinence, although evidence on other forms of self-help materials is mixed 1.
From the FDA Drug Label
Varenicline tablets are indicated for use as an aid to smoking cessation treatment. The efficacy of NICOTROL Inhaler therapy as an aid to smoking cessation was demonstrated in two single-center, placebo-controlled, double-blind trials with a total of 445 healthy patients.
The most effective smoking cessation treatment cannot be directly determined from the provided drug labels, as they do not contain a direct comparison of the efficacy of varenicline and nicotine inhaler.
- Varenicline: The label does not provide specific quit rates or comparison to other treatments 2.
- Nicotine Inhaler: The label reports quit rates of 44-45% at 6 weeks, 31-32% at 3 months, and 20-21% at 6 months, compared to placebo 3.
From the Research
Smoking Cessation Treatments
The most effective smoking cessation treatment is a topic of ongoing research. Several studies have compared the efficacy of different treatments, including nicotine replacement therapy (NRT), bupropion, and varenicline.
Efficacy of Treatments
- Varenicline has been shown to be more effective than bupropion and NRT in several studies 4, 5, 6.
- A study published in the Archives of Internal Medicine found that varenicline had a continuous quit rate of 48.0% at 6 weeks, compared to 33.3% for bupropion and 17.1% for placebo 6.
- Another study published in Current Oncology Reports found that varenicline had an odds ratio of 3.09 for efficacy, compared to 1.77 for NRT and 1.94 for bupropion 5.
Comparison of Treatments
- A study published in Expert Opinion on Pharmacotherapy found that varenicline was at least as effective as bupropion for smoking cessation, and probably more effective 4.
- A study published in European Respiratory Review found that varenicline alone was more effective than either NRT or bupropion SR, and that combination of two NRTs was equally effective to varenicline 7.