Prescription Medicines to Help You Quit Tobacco

There are prescription medicines that have been shown to help people quit tobacco. Some can be used along with nicotine replacement therapy (NRT). These medicines are often started in the weeks before your Quit Day (the day you plan to quit).

Is quit-tobacco medicine right for me?

People who are dependent on nicotine should think about nicotine replacement and/or medicine therapy to help them quit. Signs of nicotine dependence in people who smoke include:

• Smoking more than 1 pack a day
• Smoking within 5 minutes of waking up
• Smoking even while sick
• Waking up at night to smoke
• Smoking to ease symptoms of withdrawal

The more of these that apply, the more serious the dependence.

Before you start

Talk to your health care provider if you think you might want to use one of these medicines to help you quit tobacco. You’ll need a prescription. It's also a good idea to talk to your health insurance about coverage for these medicines.

If you plan to use a prescription medicine to quit tobacco, talk with your health care provider about when to start the medicine and how to use it. Also, ask what side effects you should watch for and report.

Create a reminder (like a calendar note or phone alarm) to help you remember when to start the medicine.

Varenicline (Chantix)

Varenicline (also called Chantix) is a prescription medicine FDA-approved to help people stop smoking. It has 2 effects:

• Lessens the pleasure a person gets from smoking
• Reduces the symptoms of nicotine withdrawal

Varenicline has also shown to be helpful for people trying to quit smokeless tobacco. It can increase the chance of quitting when compared to taking no medicines at all, at least in the short term. (Some studies have also found NRT lozenges can help.)

How to use varenicline

You typically start taking varenicline (a pill) a week before your Quit Day. Or, you can start taking varenicline and then pick a quit date in the next few weeks. Be sure to quit using tobacco on the date you choose.

Take it after meals, with food or a full glass of water. The daily dose increases over the first 8 days you take it. If you have problems with the higher doses, a lower dose may be used while you try to quit.

Typically, varenicline is given for 12 weeks, but people who quit during that time may get another 12 weeks of treatment to boost their chances of staying off tobacco. It’s important to keep up with other support systems during this time and for at least a few months after quitting.

Before you start varenicline, tell your provider about any medical conditions and allergies you have, including if you have kidney problems or might be pregnant.

Side effects of varenicline

Reported side effects of varenicline include:

• Nausea or vomiting
• Headache
• Trouble sleeping, vivid dreams, or sleepwalking
• Constipation
• Gas and diarrhea
• Changes in taste
• Skin rashes
• Heart or blood vessel problems (mostly in people who already have these problems)
• Mood or behavior changes such as depression, hallucinations, delusions, aggression, hostility, agitation, anxiety, panic, or suicidal thoughts

Ask your health care team about what to expect while taking this medicine, and what to do if you have side effects.

Be sure to let your provider know if you’ve ever had depression or other mental health problems, or if you start feeling depressed or have thoughts about suicide while taking varenicline.

Be careful driving or using heavy machinery as varenicline causes some people to feel sleepy or dizzy.

Using varenicline along with NRT (nicotine patch) or bupropion

Using varenicline along with the nicotine patch has  shown better outcomes than using varenicline alone. More people quit tobacco with this combination, and side effects appear to be about the same.

Studies are also looking at the use of varenicline and bupropion (another FDA-approved medicine, see below) together for quitting tobacco. This combination is not usually suggested right away, but it may benefit people who need more help when one medicine isn’t enough.

While there may be a benefit to combining the medicines, more research is needed to better understand the side effects that can happen when doing so.

Bupropion (Zyban)

Bupropion (also called Zyban) is another FDA-approved medicine for quitting tobacco. It’s a prescription antidepressant in an extended-release form that helps reduce cravings and symptoms of nicotine withdrawal. It acts on chemicals in the brain that are related to nicotine craving.

There are other forms of bupropion (such as Wellbutrin or Aplenzin) but these are not approved by the FDA for tobacco cessation.

How to use bupropion

Bupropion works best if it’s started 1 to 2 weeks before your quit date. The usual dosage is one or two 150 mg tablets per day.

If you’ve quit tobacco and are still quit after taking bupropion for 12 weeks, your provider may have you keep taking it for a while longer to help stop you from going back to smoking. Keep up with your other support systems during this time and for at least a few months after you quit.

You should not take bupropion if you have:

• Seizures (it can cause or worsen seizures)
• Heavy alcohol use
• Liver disease
• Bipolar (manic-depressive) illness
• Anorexia or bulimia (eating disorders)
• Treatment with monoamine oxidase inhibitor (MAOI, an older type of antidepressant)

You should also not take bupropion if you recently stopped or plan to stop using:

• Alcohol
• Certain sedatives and anti-anxiety medicines
• Medicines for epilepsy (seizures)

Before you start bupropion, tell your health care team if you plan to stop drinking or taking any of these medicines. Tell them about any allergies or medical conditions, including if you might be pregnant.

Side effects of bupropion

Reported side effects of bupropion include:

• Dry mouth
• Stuffy nose
• Trouble sleeping
• Tiredness
• Trouble focusing
• Constipation
• Nausea
• Dizziness
• Rash
• High blood pressure
• Risk of seizures
• Feeling depressed, anxious, agitated, hostile, aggressive, overly excited or hyperactive, or confused; or having suicidal thoughts

If you use bupropion, call your health care provider if you feel depressed or start thinking of suicide. Also be sure to ask what to expect while taking this drug, and what to do if you have side effects.

Bupropion can cause medicine interactions and shouldn’t be used with certain other medicines or supplements. Be sure your provider knows about everything you take, such as prescription medicines, vitamins, herbs, supplements, and any medicines you take on your own.

Examples of medicines you shouldn’t take without checking with your doctor include acetaminophen (Tylenol), diphenhydramine (Benadryl) or aspirin. Also be sure to tell every provider you see that you’re taking bupropion.

Using bupropion along with NRT (nicotine patch) or varenicline for quitting smoking

There is some consensus that using bupropion along with nicotine patches might increase the odds of quitting.

Using bupropion at the same time as varenicline is not usually suggested for initial treatment. But this combination may benefit people who need more help when one medicine is not enough. While there may be a benefit to combining the medicines, more research is needed to better understand side effects that can happen when doing so.

Other prescription medicines used to help people quit tobacco

If you can’t use bupropion or varenicline to help you quit, or if you haven’t been able to quit using them, other medicines have shown some promise.

These medicines are recommended by the Agency for Healthcare Research and Quality for this kind of use, but they haven’t been approved by the FDA for this purpose, so they are used “off-label”. They are only available with a prescription and are not recommended for pregnant women, teens, or people who smoke fewer than 10 cigarettes a day.

Nortriptyline

Nortriptyline is an anti-depressant medicine that helps reduce tobacco withdrawal symptoms. It has been found to increase chances of success in quitting smoking when compared to those taking no medicine.

Nortriptyline is usually started 10 to 28 days before your quit day to allow it to reach a stable level in your body.

Some people have side effects like dry mouth, sleepiness, nausea, weakness, anxiety, trouble urinating, constipation, changes in appetite or weight, and changes in sex drive. This medicine can affect your ability to drive or operate machinery, and certain medicines can’t be used along with it.

If you and your health care provider decide to try this medicine, be sure your provider and pharmacist know what other medicines you’re taking before you start.

Also be sure you understand how to take it and how to taper off when you’re ready to stop. The dose of nortriptyline must be slowly lowered. It cannot be stopped suddenly without the risk of serious effects.

People with heart disease should use this medicine cautiously. Be sure to tell all your health care providers that you are taking this drug.

Clonidine

Clonidine is another medicine that has been tried to help people quit. It isn’t used often, but it may be an option for people when nicotine replacement therapy and other prescription medicines don’t work.

If you plan to use this drug, be sure your health care provider and pharmacist know exactly what else you’re taking before you start.

The most common side effects of clonidine are constipation, dizziness, dry mouth, and unusual tiredness or weakness. Your health care team might want to watch your blood pressure while you are on this drug. The medicine can also affect your ability to drive or operate machinery.

You can start taking clonidine 2 to 3 days before you quit smoking. It shouldn’t be stopped suddenly. The dose must be lowered over a few days to prevent tremors, confusion, agitation, or a rapid increase in blood pressure.

Other medicines being studied to help people quit tobacco

A plant-based medicine called cytisinicline has been used in other countries for quitting tobacco. It is now being studied in the United States.

Nicotine vaccines have also been tested as a way to help people quit tobacco. So far that have not been shown to help