A study comparing five pharmaceutical approaches to quitting smoking found that mixing nicotine patches and lozenges was the most effective, in part because it seemed to best duplicate the highs and lows of nicotine addiction faced by smokers, HealthDay News reported Nov. 2.

Experts said that the patch provides a steady dose of nicotine, which smokers can suppliment with a lozenge if they experience a spike in craving. The patch/lozenge combination -- provided alongside addiction counseling -- was more effective than other interventions, achieving a 40-percent abstinence rate after six months.

"If you combine these different types of nicotine replacement you're going to get the best bang for your buck," said study lead author Megan E. Piper of the Center for Tobacco Research and Intervention at the University of Wisconsin at Madison.

The patch/lozenge combination was the only intervention studied that achieved better results than a placebo among daily smokers, researchers added. The other interventions tested were the patch alone, lozenge alone, the antidepressant bupropion (Wellbutrin), and bupropion plus lozenges.

"The question is, how many of them had to continue on the lozenge in order to stay off cigarettes?" said Len Horovitz, M.D., a pulmonary specialist at Lenox Hill Hospital in New York City. "I always tell people not to do the lozenge alone because it mimics the very thing that smoking does, which gives you a spike. Then, when you reach a trough, you pick up a lozenge -- or cigarette. Once they stopped everything, could they do without the spikes and troughs [of the lozenge], which mimics physiologically everything the cigarette is doing? Smoking is a two-pronged problem. There's nicotine dependence and a behavioral aspect to it."

The findings were published in the November 2009 issue of the Archives of General Psychiatry.