To Quit Smoking, Use Patch Plus Lozenge
Out of five different smoking cessation methods, the nicotine patch plus lozenges proved to be the most effective, according to research published in the November issue of Archives of General Psychiatry. The study is the first to compare the different products against each other.
Megan E. Piper, PhD and colleagues at the University of Wisconsin School of Medicine and Public Health found this combination to be the only modality with significantly higher abstinence from smoking compared with a placebo.
The researchers studied over 1500 adults over a period of six months who smoked at least 10 cigarettes a day. The patients were disqualified if they used any form of tobacco other than cigarettes, were currently taking the prescription medication buproprion, or had a mental health diagnosis of either psychosis or schizophrenia. All participants stated a motivation to quit smoking.
Bupropion is the generic name of the medication used as a smoking cessation drug (brand name Zyban) and as an antidepressant (Wellbutrin).
The participants were randomized to one of five treatment scenarios – nicotine lozenge alone, nicotine patch alone, sustained release buproprion alone or one of two combination therapies, buproprion plus lozenge or patch plus lozenge. The remainder of the study group received a placebo. All participants also received six individual smoking cessation counseling sessions with a case manager.
Smoking rates were assessed at one week, eight weeks, and six months after the beginning of the study.
All of the smoking cessation treatments worked better than the placebo for initial cessation and during the first week after quitting, but the therapy that provided the highest abstinence rate after six months was the patch plus lozenge combination, with a 40% success rate. The reasoning behind the successful combination is that the patch supplies a steady supply of nicotine replacement while the lozenge quells additional cravings.
In addition to initial cessation, participants who combined the patch and the lozenge were better able to remain smoke-free longer before having a cigarette or relapsing into regular smoking.
There were adverse events noted in each modality that was consistent with results from previous research: skin irritation associated with patch use, sleep disturbances and abnormal dreams for those on bupropion, and nausea for those on lozenges. Patients in the combination therapies reported more of the complications than those on single therapies or placebo. Four participants withdrew from the study, but there was only one serious event, hospitalization for seizures, which was possibly related to study medication, the researchers said.
The findings of this study complement the recommendation of the 2008 Update to the Public Health Service Treating Tobacco Use and Dependence Clinical Practice Guideline, which says that using the nicotine patch along with nicotine gum or spray is the most effective methods to quit smoking.
Denise Reynolds, RD LDN