Nicotine patch and lozenge together best for quitting

The researchers conducted a study to compare the effects of five different smoking-cessation strategies; namely nicotine lozenge alone, nicotine patch alone, Zyban alone, patch plus nicotine lozenge, and Zyban plus nicotine lozenge as opposed to a placebo.

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, Madison stated, "If you combine these different types of nicotine replacement you're going to get the best bang for your buck. 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 [at six months out]."

Clinical trial of five treatments
The clinical trial involved 1,504 smokers, all of whom had smoked around 10 cigarettes daily for the past six months. All the subjects were motivated to give up the habit.

While five groups were assigned to either one of the treatments randomly, one group received a placebo. In addition, all the participants received six sessions of personal counseling.

Investigators assessed the smoking rates at several intervals, at the end of a week, eight weeks, and at six months after the date of quitting.

At the end of the study period, the subjects were questioned if they were still smoking. In addition, the researchers measured carbon monoxide levels in their breath to ascertain abstinence.

Outcome of the smoking –cessation treatments
The researchers observed that all smoking cessation treatments showed benefits when compared to a placebo. However, the best outcome of abstinence after six months was the patch plus lozenge combination. 40 percent of the participants who used this treatment had stopped smoking.

The researchers reckon the reason behind its success could be the steady supply of nicotine replacement by the patch while the nicotine cravings were crushed by the lozenge.

The investigators also noted that 22 percent of the participants who underwent counseling, but no treatment, had quit smoking.

Participants who assigned to treatments of patches alone, lozenges alone, Zyban alone, or Zyban plus lozenges exhibited a success rate of 32 to 34 percent.

The researchers stated, "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.

“In addition, this study illustrates that after more than 20 years the patch remains a highly efficacious pharmacotherapy for helping people quit smoking.”

The findings of the study have been reported in the November issue of the Archives of General Psychiatry.