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Nicotine Patch plus Lozenge appears best for
Smoking Cessation
Newswise — In a comparison of five different smoking
cessation medications, a nicotine patch plus
a nicotine lozenge appears most effective at
helping smokers quit, according to a report
in the November issue of Archives of
General Psychiatry, one of the JAMA/Archives
journals.
“Many smokers have successfully quit using a variety of
smoking cessation pharmacotherapies, yet
there is little direct evidence on the
relative efficacies of these different
pharmacotherapies,” the authors write as
background information in the article.
“Without such evidence clinicians and
smokers lack a strong empirical basis for
recommending or selecting among them.”
Megan E. Piper, Ph.D., of the University of Wisconsin
Center for Tobacco Research and
Intervention, Madison, and colleagues
conducted a randomized clinical trial of
smoking cessation therapies involving 1,504
adults.
All had smoked at least 10 cigarettes a day during the
previous six months and were motivated to
quit.
Participants were randomly assigned to
one of six treatment groups: nicotine
lozenge alone, nicotine patch alone, bupropion alone, patch plus nicotine
lozenge, bupropion plus nicotine lozenge or
placebo.
Bupropion treatment began one week
before a designated quit date and continued
for eight weeks; all other treatments were
taken for eight to 12 weeks after the quit
date. All participants also received six
individual counseling sessions.
Smoking rates were assessed one week, eight weeks and six
months after the quit date.
When all the
treatments were compared at the six-month
point, only the individuals in the patch
plus nicotine lozenge group were more
successful in quitting than those taking
placebo.
Smokers using a patch and nicotine lozenge were also more
likely to have quit at seven days and tended
to have other more positive outcomes, such
as a longer period of time before relapsing.
In addition, this combination along with the patch alone
were most effective at helping people
achieve at least one day of abstinence from
smoking, an important stepping stone to
successful quitting.
Previous research has combined the patch with other
nicotine replacement therapies, such as gum,
nasal spray or an inhaler. “The present
results suggest that the nicotine lozenge
can also be effective as an adjuvant
[additional treatment] to the nicotine
patch,” the authors write.
“The key seems to be that an ad libitum, or as needed,
agent must be paired with the patch; simply
using higher patch doses does not seem to
augment outcomes to the same degree.” The
lozenge, though effective with the patch,
did not appear to work any better than
placebo when used alone.
All of the interventions appeared safe and well tolerated,
the authors note. Only four of 1,504
participants withdrew from the study for
medication-related reasons.
“These findings plus recent meta-analyses published in the
2008 Public Health Service Guideline Update
suggest that a combination pharmacotherapy
comprising the nicotine patch and an ad
libitum nicotine replacement therapy should
be routinely considered for use as a smoking
cessation treatment,” the authors write.
“In addition, this study illustrates that after more
than 20 years the patch remains a highly
efficacious pharmacotherapy for helping
people quit smoking.”
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