- Prescribing Advice for GPs - https://www.prescriber.org.uk -

Varenicline versus NRT

Addiction has published the results of a study comparing the effectiveness of varenicline with nicotine replacement for smoking cessation. The study also evaluated the safety and efficacy of varenicline in people with mental illness.

The study was conducted in a tobacco dependence clinic operated by the NHS and involved 412 patients. 208 received varenicline and 204 received NRT in addition to routine care including support sessions. There is no indication that the study was randomised or blinded.

The results of the study found a higher 4-week quit rate (72.1% with varenicline, 61.3% with NRT, difference 10.8% [95% CI 1.8% to 19.9%]). Significantly more patients in the varenicline group experienced side effects including nausea, disturbed sleep, vivid dreams, drowsiness and low mood/depression.

Varenicline has been reviewed by the National Institute for Health and Clinical Excellence (NICE) and has also been the subject of a safety review conducted by the Medicines Healthcare products Regulatory Agency (MHRA) in conjunction with the European authorities.

Action: Clinicians should follow current NICE and MHRA guidance. Varenicline is an option along with nicotine replacement therapy and bupropion, but its use should be avoided in patients with underlying mental illness.

Adapted from an article on the NPCi blog.