Varenicline plus naltrexone may aid in smoking cessation, drinking reduction

Varenicline alone is an adequate therapy for smoking cessation in heavy-drinking smokers, but combining it with naltrexone may provide benefits in terms of drinking outcomes, particularly during the 12-week period of active medication treatment, suggests a study.

This phase II randomized double-blind clinical trial compared the combination of varenicline-naltrexone with varenicline alone for smoking cessation and drinking reduction among heavy-drinking smokers. A total of 165 daily smokers and heavy drinkers received either 2 mg/day of varenicline plus 50 mg/day of naltrexone or 2 mg/day of varenicline plus matched placebo pills for 12 weeks.

The primary outcomes included 7-day point prevalence of nicotine abstinence (bioverified by a breath CO reading ≤5 ppm) at the 26-week follow-up and number of drinks per drinking day during the 12-week treatment phase.

At week 26, smoking abstinence was significantly higher among participants on varenicline plus placebo than those on varenicline plus naltrexone (45.1 percent vs 26.5 percent). For drinks per drinking day, outcomes favoured the combination of varenicline and naltrexone over varenicline alone across the 12-week treatment period; however, the medication effect did not meet the significance threshold.

“These findings suggest that smoking cessation and drinking reduction can be concomitantly targeted with pharmacotherapy,” the authors said.

“Pharmacological treatments that can concomitantly address cigarette smoking and heavy drinking stand to improve healthcare delivery for these highly prevalent co-occurring conditions,” they noted.