Smoking cessation medications
Smoking cessation - medications; Smokeless tobacco - medications; Medications for stopping tobacco
Your health care provider can prescribe medicines to help you quit tobacco use. These medicines do not contain nicotine. They work in a different way than nicotine patches, gums, sprays or lozenges. They are not habit-forming.
These medicines can:
- Help with the craving for tobacco.
- Help you with 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 doctor, counselor, or support group.
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.
Bupropion should not be used for people who:
- Are under age 18.
- Are pregnant.
- Have a history of medical problems such 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 to 2 weeks before you plan to stop smoking. You can take it for 6 months to a year.
- The most common dose is a 150 mg tablet once or twice a day.
- If you need help with cravings when first quitting, you may take bupropion along with nicotine patches, gums, or lozenges. Ask your doctor if this is okay 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 (such as anger, agitation, depressed mood, thoughts of suicide, or attempted suicide).
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. You will take it for 12 to 24 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 doctor 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.
The following medicines may help when other treatments have not worked. The benefits are 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.
American Cancer Society. Guide to quitting smoking. Last revised February 6, 2014. Available at: www.cancer.org/%20healthy/stayawayfromtobacco/guidetoquittingsmoking/index. Accessed June 1, 2015.
Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2012 Apr 18;4:CD006103. PMID: 22513936 www.ncbi.nlm.nih.gov/pubmed/22513936.
George TP. Nicotine and tobacco. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 32.
U.S. Department of Health and Human Services Tobacco Use and Dependence Guideline Panel. Treating Tobacco Use and Dependence: 2008 Update. PMID: NBK63952 www.ncbi.nlm.nih.gov/books/NBK63952. Accessed June 1, 2015.
Reviewed By: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.