The US Public Health Service recommends five nicotine replacement therapy (NRT) products and two non-nicotine medications (bupropion and varenicline).1 The NRT products are the most commonly used medications in clinical settings.2 Bupropion and varenicline, although relatively safe and effective, have recent black box warnings and enhanced surveillance recommendations for patients with mental health problems, making the NRT products alone or in combination a more appealing drug of choice.3 Piper and colleagues' study is important because there have been few head-to-head comparisons of the effectiveness of these first-line medications, in particular the nicotine patch plus nicotine lozenge.

This was a well-designed, longitudinal, randomised placebo-controlled clinical trial examining a selection …