HealthDay News — Varenicline in combination with nicotine replacement therapy (NRT) is more effective than varenicline alone in achieving tobacco abstinence at 12 weeks and at six months, according to researchers.

“Behavioral approaches and pharmacotherapy are of proven benefit in assisting smokers to quit, but it is unclear whether combining nicotine replacement therapy with varenicline to improve abstinence is effective and safe,” wrote Coenraad F.N. Koegelenberg, MD, PhD, of Stellenbosch University in Cape Town, South Africa, and colleagues. Their findings were published in of the Journal of the American Medical Association.

To determine cessation rates, researchers randomized 446 healthy smokers (1:1) to receive varenicline plus either a nicotine or placebo patch. Patch treatment began two weeks before a target quit date (TQD; one week for varenicline) and continued for 12 additional weeks. Exhaled carbon monoxide measurements confirmed tobacco abstinence at TQD and at intervals up to 24 weeks.

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The combination treatment was associated with a higher continuous abstinence rate at 12 weeks (55.4% versus 40.9%; odds ratio 1.85; P=0.007) and at 24 weeks (49.0% versus 32.%; OR, 1.98; P=0.004), as well as point prevalence abstinence rate at six months (65.1% versus 46.7%; OR, 2.13; P=0.002).

There was a numerically greater incidence of adverse effects (nausea, sleep disturbance, skin reactions, constipation, and depression) in the combination treatment group, but only skin reactions reached statistical significance (14.4% versus 7.8%; P=0.03).

“Varenicline in combination with NRT was more effective than varenicline alone at achieving tobacco abstinence at 12 weeks (end of treatment) and at 6 month,” wrote the researchers.


  1. Koegelenberg C et al. Journal of the American Medical Association. 2014; doi: 10.1001/jama.2014.7195.


Several authors disclosed financial ties to pharmaceutical companies, including Pfizer, which manufactures varenicline and funded the study.