In long-term smoking cessation, how does bupropion compare with varenicline?

• A. More effective
• B. Equally effective
• C. Less effective
• D. Not studied

Answer: (C)

In long-term smoking cessation, varenicline generally achieves higher abstinence rates than bupropion, so bupropion is considered less effective when compared directly over the long term.

Varenicline works as a partial agonist at the alpha4beta2 nicotinic receptors, which helps reduce withdrawal symptoms while also blunting the rewarding effects of nicotine. This dual action tends to translate into higher quit rates that persist after treatment ends.

Bupropion helps with withdrawal by elevating dopamine and norepinephrine levels, which can ease cravings, and it also acts as a nicotinic receptor antagonist to some extent. However, the overall long-term abstinence outcomes are typically more favorable with varenicline than with bupropion.

So, in head-to-head long-term comparisons, varenicline outperforms bupropion, making bupropion the less effective option of the two for sustained cessation.