June 2025
Varenicline significantly improves vaping cessation outcomes in youth, finds study
By Melanie Hinze
Varenicline, in combination with behavioural counselling, significantly improves vaping cessation rates in adolescents and young adults, a US randomised trial has found.
Published in JAMA, the trial included 261 participants aged 16 to 25 years who vaped nicotine daily or near-daily and were motivated to quit. Participants had no regular tobacco smoking history and were screened for nicotine dependence (E-Cigarette Dependence Inventory score ≥4), confirmed via cotinine testing.
Participants were randomised to one of three groups: 12 weeks of varenicline (1 mg twice daily), matched placebo or enhanced usual care, which consisted of text-based support only. All participants receiving medication or placebo also underwent weekly 20-minute behavioural counselling.
Varenicline recipients achieved significantly higher abstinence rates, with 51% reporting continuous abstinence between weeks nine and 12, compared with 14% in the placebo group. Between weeks nine and 24, 28% reported continuous abstinence versus 7% in the placebo group.
Varenicline recipients also had higher abstinence rates compared with those receiving enhanced usual care between weeks nine and 12 (56% vs 6%, respectively) and weeks nine and 24 (28% vs 4%, respectively).
Medication adherence was high, and adverse events were mild and transient. No drug-related serious events occurred. The most common side effects were nausea and vivid dreams. Both groups using behavioural counselling attended most sessions.
‘Varenicline, when added to brief, remotely delivered behavioral counseling, is well-tolerated and promotes vaping cessation compared with placebo in youth with moderate to severe addiction to vaped nicotine,’ the study authors concluded.
Commenting on the findings, Professor Nick Zwar, Executive Dean of Health Sciences and Medicine at Bond University, and Chair of the RACGP Smoking Cessation Guidelines Expert Advisory Group, said, ‘It is pleasing to see high-quality evidence being published on options to assist people to stop nicotine vaping.’ He said it was an important challenge and there was a lack of published research.
‘It is important for Australian doctors to understand that varenicline is only licensed for [people aged] 18 years and over in Australia for the purpose of smoking cessation, so use for nicotine vaping in [those] under 18 years would be off-label and this would need to be explained to patients,’ he said.