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Combination Nicotine Replacement Therapy for Smoking Cessation

Rationale, Efficacy and Tolerability

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Abstract

Currently available nicotine replacement therapy (NRT) medications provide effective treatment for tobacco dependence, typically doubling success rates compared with placebo. A strategy for further improving the efficacy of NRT is to combine one medication that allows for passive nicotine delivery (e.g. transdermal patch) with another medication that permits ad libitum nicotine delivery (e.g. gum, nasal spray, inhaler). The rationale for combining NRT medications is that smokers may need both a slow delivery system to achieve a constant concentration of nicotine to relieve cravings and tobacco withdrawal symptoms, as well as a faster acting preparation that can be administered on demand for immediate relief of breakthrough cravings and withdrawal symptoms.

This article reviews 5 published studies that have examined the effectiveness of combination NRT compared with monotherapy in providing withdrawal relief and smoking cessation, and examines other factors relevant to the promotion of combination NRT for treating tobacco dependence.

The data show that there are conditions under which combinations of NRT products provide greater efficacy in relieving withdrawal and enabling cessation than monotherapy, but the findings are not robust and additional research is warranted to better understand the magnitude and generality of the benefits of combination therapy. There are also regulatory and commercial obstacles that must be considered. Nonetheless, combination NRT has the potential to provide effective treatment of tobacco dependence in persons whose dependence is refractory to currently available treatments.

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Acknowledgements

Funding for preparation of this manuscript was provided primarily by Pinney Associates as part of its commitment to public health. We also gratefully acknowledge the contribution of GlaxoSmithKline Consumer Healthcare, for supporting some of this analysis with unrestricted funding for public health communications to Pinney Associates.

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Authors and Affiliations

  1. Pinney Associates, 4800 Montgomery Lane, Suite 1000, Bethesda, Maryland, 20814, USA

    Christine T. Sweeney, Reginald V. Fant & Jack E. Henningfield

  2. Smokers Information Center and Fagerstrom Consulting, Helsingborg, Sweden

    Karl O. Fagerstrom

  3. GlaxoSmithKline Consumer Healthcare, Pittsburgh, Pennsylvania, USA

    Joseph F. McGovern

  4. Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Jack E. Henningfield

Authors
  1. Christine T. Sweeney
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  2. Reginald V. Fant
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  3. Karl O. Fagerstrom
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  4. Joseph F. McGovern
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  5. Jack E. Henningfield
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Correspondence to Christine T. Sweeney.

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Sweeney, C.T., Fant, R.V., Fagerstrom, K.O. et al. Combination Nicotine Replacement Therapy for Smoking Cessation. Mol Diag Ther 15, 453–467 (2001). https://doi.org/10.2165/00023210-200115060-00004

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