Varenicline, nicotine patch treatment effectively curbs smoking among heavy drinkers

Among smokers who drank heavily, treatment with both varenicline and a nicotine patch more effectively curbed smoking than nicotine patch and placebo, according to results of a study published in JAMA Network Open.

“Tobacco and alcohol use are among the top three leading contributors to preventable disease and injury in the U.S. and cause significant public health and economic burdens,” Andrea King, PhD, of the department of psychiatry and behavioral neuroscience at the University of Chicago, and colleagues wrote. “Moreover, many people concurrently use both substances, resulting in high rates of cancer and pulmonary and cardiovascular disease, with mortality beyond the risks of each substance individually.”

King and colleagues sought to ascertain whether treatment combining varenicline tartrate and a nicotine patch increased abstention from cigarette smoking among smokers who drink heavily.

The double-blind, placebo-controlled, superiority randomized clinical trial was conducted at two outpatient sites in Chicago between March 26, 2018, and Feb. 14, 2020. It included 122 participants who smoked between five and 30 cigarettes per day and drank heavily (more than 14 drinks per week for men or more than seven drinks per week for women; at least one heavy drinking day per month for the previous year) and expressed a desire to quit smoking. During the 12-week trial, participants who were randomly assigned equally between the varenicline/patch group and patch/placebo group were given either 1 mg of varenicline tartrate or matching placebo twice per day. Nicotine patches were used at manufacturer-recommended doses for 10 weeks. Study participants also underwent brief individual smoking cessation counseling the week before quit date and on the quit date.

Results showed higher smoking cessation rates during the final weeks of the study among those treated with varenicline vs. placebo (44.3% vs. 17 participants 27.9%), and decreased probability of relapse for duration of treatment in the varenicline group compared with the placebo group. Although both treatments were well-tolerated, participants in the varenicline group reported more adverse effects, with five participants in the varenicline group discontinuing medication.

“The results support continued investigation of varenicline with nicotine patch as a combination treatment strategy for smokers with hazardous drinking behaviors who have historically experienced worse outcomes with standard approved tobacco cessation treatments,” King and colleagues wrote.