• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Does Augmenting Varenicline with Bupropion Work Better than Varenicline Alone?

Does Augmenting Varenicline with Bupropion Work Better than Varenicline Alone?

February 27, 2019
Jessica Goren, PharmD.
From The Carlat Addiction Treatment Report
Issue Links: Learning Objectives | Editorial Information
Jessica Goren, PharmD. Dr. Goren has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Review Of: Cinciripini PM et al, Addiction 2018;113:1673-1682

We have a good array of smoking cessation treatments to choose from, including nicotine replacement therapy (NRT), bupropion, and varenicline. Varenicline is the most effective monotherapy agent, somewhat better than bupropion and single-product NRT, and comparable to combination NRT. Theoretically, adding bupropion to varenicline would be even more effective. A couple of studies have tested this strategy with mixed results. This latest study attempted to further clarify the efficacy of this combination.

Researchers randomly assigned smokers (at least 1 pack per day) to three treatment arms: varenicline alone (n=166), varenicline plus bupropion (n=163), and placebo (n=56). All participants were also given behavioral therapy (13 in-person individual 15-minute visits for smoking cessation counseling and two brief supportive telephone sessions) for 12 weeks of active treatment. They were then followed for 12 months. The primary outcome measure was abstinence at 1 year, which was verified by measuring expired carbon monoxide. The majority of participants were male (58%), and the average age was 49.

After 12 months, the quit rates were similar in the two active treatment groups. Beginning with the last four weeks of treatment, participants on varenicline had a continuous abstinence rate of 22.29% vs 20.25% for the varenicline+bupropion group. Both of these were superior to placebo, with a continuous abstinence rate of 5.36%.

As expected, the rate of adverse events was higher in the combination (98.1%) and varenicline only (95.78%) groups compared with placebo (89.29%, p<0.021). Specifically, varenicline+bupropion participants experienced decreased appetite, altered taste, and increased dry mouth, insomnia, creatinine and edema compared with placebo. Varenicline only participants had increased rates of abnormal dreams, diarrhea, and nausea compared with placebo.

CATR’s Take
While it’s tempting to combine two effective treatments, it appears that adding bupropion to varenicline is no better than varenicline alone. While all agents can be used as first line treatment, in the Carlat Medication Fact Book, we lay out an approach to smoking cessation that starts with nicotine replacement therapy, and then moves on to either varenicline or bupropion. These results appear to be in line with that approach.
Addiction Treatment
KEYWORDS bupropion research-update smoking-cessation varenicline
    Jessica Goren, PharmD.

    Medications to Treat OCD: What Psychotherapists Need to Know

    More from this author
    www.thecarlatreport.com
    Issue Date: February 27, 2019
    SUBSCRIBE NOW
    Table Of Contents
    CME Post-Test - Traumatic Brain Injury and Addiction, CATR, March/April 2019
    Switching from Buprenorphine to Extended-Release Naltrexone: Does it Work?
    Does Augmenting Varenicline with Bupropion Work Better than Varenicline Alone?
    The FDA Campaigns Against Flavored Tobacco Products
    Assessing Traumatic Brain Injury in Patients with Substance Use Disorders
    Traumatic Brain Injury: Definition, Classification, and Management
    Featured Book
    • OUDFB1e_Cover_Binding.png

      Treating Opioid Use Disorder—A Fact Book (2024)

      All the tools you need to assess and treat patients struggling with opioid use disorder. 
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2622607431.jpg
      General Psychiatry

      Should You Test MTHFR?

      MTHFR is a...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.