The Best Chance for Smoking Cessation: Patch & Lozenge Combo

A smoker who is trying to kick the habit has the best odds for triumph over cravings by utilizing a nicotine patch in combination with a nicotine lozenge. This is the key finding of a first ever study that compared the effectiveness of several popular smoking cessation products used alone or in various combinations. The results of the analysis appear in the November issue of the Archives of General Psychiatry.

The patch-lozenge combination therapy was shown to be more successful than other methods studied, including antidepressant use. The reasoning behind the success of the patch when used in conjunction with the lozenge holds that the combination offers the best imitation of the actual highs and lows associated with nicotine addiction. While the patch supplies a constant supply of nicotine replacement, the lozenge supplies a boost of nicotine for those times that smokers have an extra craving. By using the two treatments together smokers are given the control they need to quit.

According to Megan E. Piper, lead author of the study and an assistant professor at the Center for Tobacco Research and Intervention at the University of Wisconsin in Madison, “If you combine these different types of nicotine replacement you're going to get the best bang for your buck.” She then added, “But also remember that in this study people got a lot of counseling. It was that combination that resulted in a 40 percent quit rate.”

In measuring the success rate for smoking cessation at six months after the initial quit date, results indicated that only the patch-lozenge intervention performed better than a placebo. Smokers who used the patch-lozenge combination were also more likely to have stopped smoking after only one week. In addition, they were more likely to have achieved one full day without smoking.

Piper noted that this type of research has not been done in the past due to cost constraints and other factors. She stated, “As each medication comes out, it is tested against a placebo” but never compared to other smoking cessation methods.

The study involved 1,504 adult smokers who expressed a desire to quit. All participants had smoked at least 10 cigarettes per day for six months prior to the study. They were randomly assigned to receive a placebo, or one of five different smoking cessation interventions that included either nicotine lozenge, nicotine patch, the antidepressant bupropion (also marketed as Zyban and Wellbutrin), nicotine patch plus nicotine lozenge, or bupropion plus nicotine lozenge. Therapy lasted for 8 to 12 weeks, and smoking rates were assessed at one week, eight weeks, and six months after the quit date. In addition, each participant received a total of six individual counseling sessions with an assigned case manager.

GlaxoSmithKline, marketer of Wellbutrin, provided free medication to patients. A second prescription drug, marketed by Pfizer and known as Chantix, is also approved for smoking cessation use in the United States. However, Chantix was not included in the study.

Only one serious adverse event occurred during the study period, which involved hospitalization of a participant for seizures that were possibly related to the study medication. The study was supported by a grant from the National Institute on Drug Abuse and the National Center for Research Resources.

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