Q&A: Inclusion of bupropion and varenicline in the WHO Model List of Essential Medicines

Bupropion and varenicline are non-nicotine pharmacotherapies for smoking cessation. Bupropion may reduce cravings and symptoms of nicotine withdrawal through its competitive inhibitory effect on nicotinic receptors. Varenicline can reduce cravings and nicotine withdrawal symptoms through its ability to serve as a partial nicotine receptor agonist and a nicotine receptor antagonist. 

In the latest edition of WHO EML, varenicline and bupropion are now listed under section 24.5 “Medicines for disorders due to psychoactive substance use”, together with nicotine replacement therapy (nicotine gum and patch). With these additions, a total of three pharmaceutical approaches for smoking cessation are now present on the WHO EML.

WHO is encouraging governments to make them widely available by including them in national essential medicines list. Both medications are available by prescription in nearly 90 countries and partially or fully cost-covered in 45 countries.

The inclusion of the two medications on the WHO Essential Medicines List aims to encourage governments to broaden the support and services provided to help smokers quit tobacco. Both medications are providing alternative treatment options, as an addition to nicotine replacement therapy, for people who want to stop smoking. Tobacco users are also recommended to use other quitting tools such as toll-free quit lines, chatbots and quit apps like WhatsApp, Viber and Florence.

• The inclusion of two new non-nicotine smoking cessation medications on WHO EML calls for national governments to broaden the scope of tobacco cessation services provided.
• Countries should consider using WHO EML to update their national essential medicines lists and taking complementary measures such as voluntary licensing mechanisms, pooled procurement, and price negotiation to promote equitable and affordable access to three evidence-based smoking cessation medications.
• Countries should incorporate these medicines in more comprehensive approach to promote smoking cessation such as advice from physicians, national toll-free quit line and behavioral interventions delivered via mobile text messaging (mCessation).
• Countries should consider providing cost-coverage for the use of NRT, bupropion and varenicline by tobacco users.
• Countries should consider recommending NRT, bupropion and varenicline in their national clinical treatment guidelines for tobacco cessation following the upcoming WHO Clinical Treatment Guideline for Tobacco Cessation.