Lozenge/Patch Combo Best for Kicking Butts

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Smokers are more than twice as likely to quit if they use the nicotine patch along with nicotine lozenges—compared to lozenges or patches alone, buproprion (Xyban), buproprion plus the lozenges or placebo.  The trial was the largest study ever to compare these approaches head to head, and included 1,504 smokers.

All of the treatment groups did better than placebo—but the effect was strongest for the patch/lozenge combination, 40% of whom successfully kicked the habit.  Smokers using this combo were not only more likely to quit, but also less likely to have a “slip” prompt a return to regular smoking.

The study adds support to a growing body of research that suggests that offering addicts access to drugs similar to their drug of choice—or even that drug itself—can actually help them quit or at least dramatically reduce the harm associated with their addiction.

The study was conducted by Megan Piper, PhD, of the University of Wisconsin Center for Tobacco Research and Intervention and colleagues and published in the November issue of the Archives of General Psychiatry.

“While the nicotine lozenge, bupropion, and bupropion plus lozenge produced effects that were comparable with those reported in previous research, the nicotine patch plus lozenge produced the greatest benefit relative to placebo for smoking cessation,” the authors conclude.

To participate in the research, smokers had to have smoked at least 9 cigarettes a day for at least six months.  All were given supportive counseling and received medications or placebo for eight to twelve weeks, as appropriate for the particular treatment.  They were asked about their smoking and tested using a device similar to an alcohol breathalyzer one week after their quit date and again six months later.

The key to the effectiveness of the combo seemed to be that the patch provided a steady nicotine level to reduce cravings prompted by withdrawal—and smokers could also use the lozenges when they felt cravings due to stress or exposure to situations in which they usually smoked.

Unfortunately, the study did not include the most recently FDA-approved medication for smoking cessation—varenicline (Chantix).  According to a review of the research by the Cochrane Collaboration—an organization that rigorously reviews research and is often relied upon by health care agencies to guide treatment decisions—varenicline is more effective than buproprion and also more effective than the patch alone.

The good news is that smokers have more options to help them quit than ever before—and that the more times people try to quit, the more likely they are to eventually be successful.  The patch plus lozenge combination seems like a good place to start.