Smoking Cessation -- What to Do After Initial Failure?

Background: Quitting smoking is very difficult, often requiring multiple attempts. Various strategies enhance the odds of initial success, but what should practitioners advise after initial failure or relapse to smoking? Objective: To determine the best strategy after failure of varenicline or combined nicotine replacement therapy (CNRT). Design: Double-blind, randomized, placebo-controlled sequential strategy study. Participants/Methods: 490 volunteers were randomized to receive either 2 mg/day of varenicline or CNRT (21 mg patch + 2 mg lozenge prn) for 6 weeks. Those who failed smoking cessation were re-randomized to the same therapy, switched to the alternative therapy, or to increased dosage of 3 mg/day of varenicline or 42 mg/day nicotine patch + 2 mg lozenges for another 6 weeks. The primary outcome was 7-day abstinence at 12 weeks defined as self-report + measured expired carbon monoxide level. The secondary outcome was continued abstinence at follow-up. Results: The patient c more...