Evid Based Nurs 12:10 doi:10.1136/ebn.12.1.10
  • Treatment

Review: varenicline, bupropion, and nicotine replacement therapies are effective for smoking cessation at 6 or 12 months

M J Eisenberg

Dr M J Eisenberg, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec, Canada; mark.eisenberg{at}


How do various pharmacotherapies compare for smoking cessation?


Studies selected compared any pharmacotherapy with placebo and reported biochemically validated measures of smoking abstinence. Trials that were unblinded or that evaluated reduced cigarette use, spontaneous cessation among smokers unwilling to quit, or smokers with chronic disease were excluded. Outcome was smoking cessation.


Medline, EMBASE/Excerpta Medica, Cochrane Library, and US Centers for Disease Control and Prevention’s Tobacco Information and Prevention database were searched for randomised controlled trials (RCTs). 69 RCTs (n = 32 908) met the selection criteria. Pharmacotherapies assessed were bupropion (16 RCTs), varenicline (13 RCTs), nicotine gum (22 RCTs), transdermal nicotine (30 RCTs), nicotine inhalers (4 RCTs), nicotine nasal spray (4 RCTs), and nicotine tablets (6 RCTs). Follow-up was at 6 or 12 months.


Meta-analysis showed that bupropion, varenicline, nicotine gum, transdermal nicotine, nicotine nasal spray, and nicotine tablets are more effective than placebo for smoking cessation (table). Nicotine inhalers and placebo, and {varenicline and bupropion did not differ}* (table).

Comparisons of various pharmacotherapies with placebo for smoking cessation at 6 or 12 months*


Varenicline, bupropion, and nicotine replacement therapies are effective for smoking cessation at 6 or 12 months.

*Erratum: CMAJ 2008;179:802.


Eisenberg MJ, Filion KB, Yavin D, et al. Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. CMAJ 2008;179:135–44.

Clinical impact ratings: Family/general practice 6/7; Health promotion 6/7


  • Source of funding: Canadian Institutes of Health Research.


Although smoking rates in developed countries have decreased over the past few decades, they are on the rise in developing countries, and globally, about one-third of adult men smoke.1 It is widely known that tobacco use is the most preventable cause of premature death and disease. For instance, in 2002, an estimated 37 209 Canadians died from illnesses related to tobacco use, accounting for 17% of all deaths in Canada.2

The meta-analysis by Eisenberg et al provides evidence to support the use of pharmacotherapeutic interventions. In 69 included RCTs, varenicline, bupropion, and 5 nicotine replacement therapies were more effective than placebo for promoting smoking abstinence at 6 or 12 months. Bupropion and varenicline did not differ. Although the results are useful for selecting pharmacotherapeutic interventions, they do not address the effectiveness of such therapies compared with well-conducted cognitive support therapy, self-help, clinician-led interventions, or other non-pharmacological cessation initiatives.

According to the Canadian Tobacco Use Monitoring Survey report, only 54% of smokers who visited healthcare professionals in the preceding 12 months reported being advised to reduce or quit smoking.3 The results of this meta-analysis are applicable to family practice nurses, advanced practice nurses, and all healthcare providers involved in primary prevention and ongoing chronic disease management and smoking cessation interventions. It is important to note, however, that incorporating only pharmacotherapies in a treatment plan for smoking cessation is not widely considered to be a comprehensive approach. Regardless of the specific intervention, clinicians must take every opportunity to discuss smoking cessation strategies with patients.


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