Quitting Smoking When the Nicotine Patch Is Not Enough

Quitting cigarette smoking is difficult, even with nicotine patches. In a two-stage, controlled trial, 349 community-recruited smokers used the nicotine patch for 1 week; 221 nonresponders (46% men; mean cigarettes/day, 21; mean years of smoking, 26) were randomized to 12 weeks of varenicline (0.5 mg/day for 3 days; gradually increased to 1.0 mg twice daily by day 8) alone or with bupropion (150 mg/day for 3 days; 150 mg twice daily thereafter). The authors have financial interests in smoking cessation technologies.

Abstinence was determined by self-report confirmed by expired-air CO measurements. About 36% of participants dropped out, with similar numbers in each arm. Intent-to-treat analyses at study completion showed superiority for combi…