Comparison between the role of bupropion and varenicline in the management of nicotine dependence: A prospective comparative study

Introduction: Smoking is a leading preventable cause of morbidity and mortality worldwide, linked to diseases such as lung cancer, cardiovascular disorders, and chronic obstructive pulmonary disease. Despite awareness of its harmful effects, smoking cessation remains challenging due to nicotine addiction. According to the Global Adult Tobacco Survey-2, India has 266.8 million tobacco users aged 15 years or older. This study compares the effectiveness of bupropion (BUP) and varenicline (VAR) in tobacco cessation, focusing on abstinence rates and reduction in dependence levels. Materials and Methods: An open-label, prospective, randomized controlled study was conducted over 6 months with 90 patients divided into two groups: Group A (smoking tobacco users) and Group B (smokeless tobacco users). Fagerström Test for Nicotine Dependence (FTND) and FTND-Smokeless Tobacco (FTND-ST) were used as assessment tools. Observations and Results: Results showed that among smoking tobacco users, VAR achieved a higher quit rate (72%) compared to BUP (48%) at 6 months ( P = 0.028). Conversely, among smokeless tobacco users, BUP demonstrated superior efficacy with a quit rate of 70% versus 50% for VAR ( P = 0.012). Conclusion: The findings suggest that VAR is more effective for smoking cessation due to its partial agonist action at nicotinic receptors, reducing withdrawal symptoms and nicotine reinforcement. BUP’s modulation of dopamine and norepinephrine levels appears better suited for smokeless tobacco cessation, addressing withdrawal symptoms associated with sensory and ritualistic use. Tailoring cessation programs to specific types of tobacco dependency is crucial for improving outcomes.