Varenicline and Nicotine Replacement Together Are Better Than Varenicline Alone

Varenicline supports smoking cessation by acting as both a nicotine antagonist and a partial agonist; both actions might neutralize the benefit of nicotine-replacement therapy. In the few published studies of combined therapy, no significant benefit was reported. To investigate further whether combination therapy might be effective, researchers in South Africa randomized 446 adult long-term smokers (mean age, 46; mean pack-years of smoking, 21) to 12 weeks of varenicline (Chantix; titrated to 1 mg twice daily) plus nicotine replacement patches (15 mg, worn for 16 hours daily) or to varenicline plus placebo patches. People with chronic medical and psychiatric illnesses were excluded.

The 4-week continuous abstinence rates (during weeks 9–12, …