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Home > Nicotine receptor partial agonists for smoking cessation.

Cahill, Kate and Lindson-Hawley, Nicola and Thomas, Kyla H and Fanshawe, Thomas R and Lancaster, Tim [The Cochrane Library] . (2016) Nicotine receptor partial agonists for smoking cessation. London: John Wiley & Sons, Ltd. Cochrane Database of Systematic Reviews (5) DOI: 10.1002/14651858.CD006103.pub7


From the information we found (27 trials, 12,625 people), varenicline at standard dose more than doubled the chances of quitting compared with placebo. Low-dose varenicline (four trials, 1266 people) roughly doubled the chances of quitting, and reduced the number and severity of side effects. The number of people stopping smoking with varenicline was higher than with bupropion (five trials, 5877 people) or with NRT (eight trials, 6264 people). Based on the evidence so far, we can calculate that varenicline delivers one extra successful quitter for every 11 people treated, compared with smokers trying to quit without varenicline.

The most common side effect of varenicline is nausea, but this is mostly at mild or moderate levels and usually clears over time. People taking varenicline appear to have about a 25% increased chance of a serious adverse event, although these include many which are unrelated to the treatment. We also note that more people were lost from the control groups than from the varenicline groups by the end of the trials, which may mean that the count of events in the control groups is lower than it should be. After varenicline became available to use, there were concerns that it could be linked with an increase in depressed mood, agitation, or suicidal thinking and behaviour in some smokers. However, the latest evidence does not support a link between varenicline and these disorders, although people with past or current psychiatric illness may be at slightly higher risk. There have also been concerns that varenicline may slightly increase heart and circulatory problems in people already at increased risk of these illnesses. The evidence is currently unclear whether or not they are caused or made worse by varenicline, but we should have clearer answers to these questions when a further study is published later this year.

Item Type
Evidence resource
Publication Type
Drug Type
Intervention Type
AOD disorder drug therapy
May 2016
John Wiley & Sons, Ltd
Place of Publication
Accession Number
HRB (Not in collection)

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