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Smoking cessation medications

Definition

Your health care provider can prescribe medicines to help you quit tobacco use. These medicines do not contain nicotine and are not habit-forming. They work in a different way than nicotine patches, gums, sprays, or lozenges.

Information

Smoking cessation medicines can help:

• Lessen the craving for tobacco

• Decrease withdrawal symptoms

• Keep you from starting to use tobacco again

Like other treatments, these medicines work best when they are part of a program that includes:

• Making a clear decision to quit and setting a quit date

• Creating a plan to help you deal with smoking urges

• Getting support from a provider, counselor, or support group

BUPROPION (Zyban)

Bupropion is a pill that may cut down your craving for tobacco.

Bupropion is also used for people with depression. It helps with quitting tobacco, even if you do not have problems with depression. It is not fully clear how bupropion helps with tobacco cravings and quitting tobacco.

Bupropion should not be used for people who:

• Are under age 18

• Are pregnant

• Have a history of medical problems such as seizures, kidney failure, heavy alcohol use, eating disorders, bipolar or manic depressive illness, or a serious head injury

How to take it:

• Start bupropion 1 week before you plan to stop smoking. Your goal is to take it for 7 to 12 weeks. Talk with your doctor before taking it for a longer period of time. For some people, taking it longer helps prevent resuming smoking, and this is considered safe to do if needed.

• The most common dose is a 150 mg tablet once a day, going up to twice per day after 3 days with at least 8 hours between each dose. Swallow the pill whole. DO NOT chew, split, or crush it. Doing so can cause side effects, including seizures.

• If you need help with cravings when first quitting, you may take bupropion along with nicotine patches, gums, or lozenges. Ask your provider if this is OK for you.

Side effects of this medicine may include:

• Dry mouth.

• Problems sleeping. Try taking the second dose in the afternoon if you have this problem (take it at least 8 hours after the first dose).

• Stop taking this medicine right away if you have changes in behavior. These include anger, agitation, depressed mood, thoughts of suicide, or attempted suicide.

VARENICLINE (CHANTIX)

Varenicline (Chantix) helps with the craving for nicotine and withdrawal symptoms. It works in the brain to reduce the physical effects of nicotine. This means that even if you start smoking again after quitting, you will not get as much pleasure from it when you are taking this drug.

How to take it:

• Start taking this medicine 1 week before you plan to quit cigarettes. Or, you can begin taking the medicine, then choose a date within 4 weeks to quit. Another way is to begin taking the medicine, then slowly stop smoking over the next 12 weeks.

• Take it after meals with a full glass of water.

• Your provider will tell you how to take this medicine. Most people take one 0.5 mg pill a day at first. By the end of the second week, you will likely be taking a 1 mg pill twice a day.

• DO NOT combine this drug with nicotine patches, gums, sprays or lozenges.

• Children under age 18 should not take this drug.

Most people tolerate varenicline well. Side effects are not common, but can include the following if they do occur:

• Headaches, problems sleeping, sleepiness, and strange dreams.

• Constipation, intestinal gas, nausea, and changes in taste.

• Depressed mood, thoughts of suicide and attempted suicide. Call your provider right away if you have any of these symptoms.

NOTE: Use of this medicine is linked to an increased risk of heart attack and stroke.

OTHER MEDICINES

The following medicines may help when other treatments have not worked. The benefits are much less consistent, so they are considered second-line treatment.

• Clonidine is normally used to treat high blood pressure. It may help when it is started before quitting. This drug comes as a pill or patch.

• Nortriptyline is another antidepressant. It is started 10 to 28 days before quitting.

References

George TP. Nicotine and tobacco. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 29.

Smokefree.gov website. Quit smoking. smokefree.gov/quit-smoking. Accessed March 23, 2023.

US Preventive Services Task Force website. Tobacco smoking cessation in adults, including pregnant persons: interventions. US Preventive Services Task Force recommendation statement. www.uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions. Updated January 19, 2021. Accessed March 23, 2023.

US Food and Drug Administration website. Want to quit smoking? FDA-approved products can help. www.fda.gov/consumers/consumer-updates/want-quit-smoking-fda-approved-and-fda-cleared-cessation-products-can-help. Updated July 21, 2022. Accessed March 23, 2023.

Review Date: 2/28/2023

Reviewed By: Jacob Berman, MD, MPH, Clinical Assistant Professor of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.