Medication to Quit Smoking

Everyone’s journey to become smoke free is different. For some, going cold turkey works best.

For others, the nicotine in tobacco products is too addictive, and they are most successful when they use medication formulated to dampen cravings for cigarettes and reduce withdrawal symptoms.

And some prefer nicotine replacement therapies, which provide nicotine in controlled doses when needed, allowing you to wean yourself from the chemical.

Each option has pros and cons, and in the end, what works for one person will not work for another.

Only you can determine the best way for you to quit.

In this article, I’ll go over the different prescription medications for smoking cessation, including bupropion, varenicline, nortriptyline, and clonidine.

I’ll also discuss the various over-the-counter (OTC) nicotine replacement therapies.

When you create your quit plan, talk to your healthcare provider, who can help you determine the best medications for you.

Prescription Medication

Using prescription quit-smoking medication for at least five weeks may increase the chance of quitting for good.

The most commonly prescribed medications are bupropion and varenicline, though other drugs may be prescribed off-label for smoking cessation. 

Bupropion (Zyban)

Bupropion (Zyban) is an antidepressant medication that is primarily used to treat major depressive disorder and seasonal affective disorder.

In 1997, it was approved as the first anti-nicotine medication.

It works by inhibiting the neural reabsorption of the neurotransmitters norepinephrine and dopamine.

This helps reduce nicotine cravings and symptoms of withdrawal, whether or not someone is taking bupropion for depression. 

For smoking cessation, it’s best to start taking bupropion 1-2 weeks before your quit date and continue for 7-12 weeks after that.

However, in some instances, your healthcare provider may recommend taking bupropion for longer.

Side effects

Take bupropion as directed by your healthcare provider and consult them if you experience any severe side effects. The most common side effects of bupropion include:

• Insomnia 
• Dry mouth
• Tremors
• Rash
• Headache 
• Weight loss
• Dizziness 
• Nausea
• Constipation 
• Rapid heartbeat

In some cases, bupropion may trigger depression, suicidal thoughts, or attempts to commit suicide.

Stop taking bupropion and contact your doctor immediately if you experience: 

• Thoughts about harming yourself
• New or worsening depression
• Unusual aggression

Bupropion is not appropriate for everyone. Talk to your doctor if:

• You are younger than 18 years old
• You are pregnant
• You have a history of seizures
• You have a history of eating disorders
• You have bipolar or manic-depressive disorders
• You take a monoamine oxidase (MAO) inhibitor
• You drink heavily

Varenicline (Chantix)

Varenicline (Chantix) is a non-nicotine drug that blocks the effects of nicotine on the brain.

Dampening the feelings of euphoria created by nicotine helps decrease cravings for cigarettes and reduces withdrawal symptoms.

It also means that if you pick up the habit again, you’ll derive less pleasure from cigarettes.

There are three ways to take varenicline:

• Pick a quit date and start the medication one week beforehand.
• Start taking the medication and pick a quit date in the next four weeks.
• Start taking the medication and slowly cut back on smoking in the next 12 weeks.

Side effects

Most people don’t experience side effects with varenicline.

When they do occur, they include:

• Nausea
• Insomnia
• Headache
• Vivid dreams
• Trouble sleeping
• Constipation
• Gas

In some cases, varenicline may trigger depression, suicidal thoughts, or attempts to commit suicide.

Stop taking varenicline and contact your doctor immediately if you experience: 

• Thoughts about harming yourself
• New or worsening depression
• Unusual aggression

Varenicline is not for everyone.

Talk to your doctor if:

• You are younger than 18 years old
• You are using nicotine replacement therapy such as nicotine gum, patches, lozenges, inhalers, or nasal sprays

Varenicline may increase the risk of stroke or heart attack, so talk to your doctor if you have any heart or blood vessel conditions, or if you experience any symptoms of a stroke or heart attack.

Nortriptyline

Nortriptyline (Pamelor) is an antidepressant medication.

Although it is not FDA approved to help with smoking cessation, one review suggests it may be as effective as bupropion or nicotine replacement therapies.

Nortriptyline is a second-line treatment, meaning it’s used if other medications or treatments don’t work, stop working, or cause unbearable side effects.

It’s best to start nortriptyline 10-28 days before your quit date. Most people using nortriptyline for smoking cessation take it for 8-12 weeks.

Side effects

The most common side effects of nortriptyline include:

• Dry mouth
• Lightheadedness
• Blurred vision
• Shaky hands
• Drowsiness

Nortriptyline is not for everyone. Talk to your doctor if:

• You are younger than 18 years old
• You are pregnant
• You have cardiovascular disease
• You take a monoamine oxidase (MAO) inhibitor

Clonidine 

Clonidine is used to treat high blood pressure and is FDA-approved to manage symptoms of attention deficit hyperactivity disorder (ADHA) in children.

Although it’s not approved by the FDA to help with smoking cessation, it may help reduce withdrawal symptoms. Clonidine comes as a patch or extended-release tablet.

Side effects

It’s important to consider the side effects of clonidine before trying this for smoking cessation.

Common adverse effects include:

• Sedation
• Dizziness
• Dry mouth

Consult your doctor if you experience any of these symptoms and before stopping your medicine.

Abrupt cessation of clonidine has resulted in severe hypertension and, in rare cases, hypertensive encephalopathy (brain dysfunction) and even death.

Clonidine is not for everyone. Talk to your doctor if:

• You are younger than 18 years old
• You are pregnant
• You have kidney disease
• You have any current or past heart problems such as heart attack, stroke, or slow heartbeat

Nicotine Replacement Therapy

Nicotine replacement therapy (NRT) works to reduce the amount of nicotine consumed through tobacco products by delivering a controlled amount to you.

It helps to satiate cravings and can be useful for heavy smokers who are trying to wean themselves off smoking. NRT does not increase the risks of a heart attack, and those with diabetes or high blood pressure can safely use them.

The levels of nicotine in NRT are also low enough that they are unlikely to interact with other medications. 

Nicotine gum, patches, lozenges, inhalers, and nasal spray are available over the counter.

Discuss these options with a healthcare provider or pharmacist to determine which is right for you. In some cases, a combination of these therapies is best.

Nicotine gum

Nicotine gum may help with quitting smoking in two ways: The nicotine absorbed through the lining of your mouth helps reduce cravings, and the gum gives your mouth something to do instead of smoking. 

Nicotine gum comes in 2-milligram (mg) and 4-mg strengths.

The best strength depends on when you have your first cigarette and how frequently you smoke.

With time, you can lower the dose and how frequently you use nicotine gum as you wean yourself off nicotine. 

Nicotine patch

Nicotine patches are worn on the skin and release a small, steady amount of nicotine to the body, which can help reduce cravings and withdrawal symptoms.

However, they do not offer immediate relief for craving episodes.

Nicotine patches come in three strengths: 7 mg, 14 mg, and 21 mg.

The right dose for you depends on how much you usually smoke.

Apply one patch to your skin per day, mixing up the location to avoid skin irritation. Unless directed by your prescriber, never wear two patches at once. 

Nicotine lozenge

Nicotine lozenges help reduce withdrawal symptoms and decrease dependence on nicotine.

These lozenges must go between the gums and cheek and slowly dissolve over 20-30 minutes for the most effect.

They can be used with nicotine patches.

Nicotine inhaler

A nicotine inhaler helps to reduce nicotine withdrawal symptoms and urges to smoke.

It looks like a cigarette and has a cartridge that contains nicotine.

When you puff, the inhaler turns the nicotine into a vapor that is absorbed in your mouth.

However, you need to puff frequently to ensure you inhale enough nicotine to have an effect. 

Nicotine nasal spray

Nicotine nasal spray comes in a handheld spray bottle and releases nicotine into your nostrils.

It raises blood nicotine levels faster than other NRTs and is typically prescribed to heavy smokers, as it can be more addictive than other replacement therapies.

Nicotine nasal spray can be used on-demand and with nicotine patches, however, it also may cause nasal irritation.

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