Prescription Medicines to Help You Quit Tobacco

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

People who are significantly dependent on nicotine should consider nicotine replacement and/or drug therapy to help them quit. Signs of severe 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.

Talk to your health care provider if you think you might want to use one of these drugs 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 medications.

If you plan to use a prescription drug to quit tobacco, talk with your health care provider about exactly when to start, and how to use the medicine. Also find out what side effects to watch for and report. Put a note on your calendar to remind you when to start taking it.

Varenicline (Chantix)

Varenicline (also called Chantix) is a prescription medicine developed to help people stop smoking. It works by interfering with nicotine receptors in the brain. This means it has 2 effects:

• It lessens the pleasure a person gets from smoking.
• It reduces the symptoms of nicotine withdrawal.

For people trying to quit smokeless tobacco, several studies have shown varenicline can increase their 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.)

You typically start taking varenicline (a pill) about a month to a week before your Quit Day. Take it after meals, with 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.

Tell your provider about any medical conditions and allergies you have before you start varenicline, including if you might be pregnant.

Side effects of varenicline

Reported side effects have included:

• Nausea
• Vomiting
• Headache
• Trouble sleeping, unusual dreams, or sleepwalking
• Constipation
• Gas
• Changes in taste
• Skin rashes
• Seizures
• 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 even suicidal thoughts

Talk to your health care team about what to expect while taking this drug, and what to do if you or others notice possible 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.

Using varenicline along with NRT or bupropion for quitting smoking

Research is being done to find out if varenicline can be used at the same time as nicotine replacement therapy (NRT). A few studies have suggested that using varenicline along with NRT is well-tolerated and safe, but others have found this has no long-term benefit in helping people quit. More research is needed.

Research on using both varenicline and bupropion at the same time is also being done. While there may be a benefit to combining the drugs vs. taking only varenicline, more research is needed to understand if this could cause more severe side effects.

Bupropion (Zyban)

Bupropion also may be called by the brand names Zyban, Wellbutrin, or Aplenzin. It’s a prescription antidepressant in an extended-release form that helps reduce cravings and symptoms of nicotine withdrawal. It does not contain nicotine. This drug acts on chemicals in the brain that are related to nicotine craving. Bupropion works best if it’s started 1 or 2 weeks before you quit smoking. The usual dosage is one or two 150 mg tablets per day.

If you’re still not using tobacco after taking bupropion for 7 to 12 weeks, your provider may have you keep taking it for some time afterward 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.

This drug should not be taken if you have or have ever had:

• Seizures (it can cause or worsen seizures)
• Heavy alcohol use
• Cirrhosis
• A serious head injury
• Bipolar (manic-depressive) illness
• Anorexia or bulimia (eating disorders)

You also shouldn’t take it if you’re taking sedatives or have recently taken a monoamine oxidase inhibitor (MAOI, an older type of antidepressant).

Tell your doctor about any medical conditions and allergies you have before you start bupropion, including if you might be pregnant.

Side effects of bupropion

Reported side effects of bupropion include:

• Dry mouth
• Stuffy nose
• Trouble sleeping and nightmares
• Tiredness
• Constipation
• Nausea
• Headaches
• High blood pressure
• Seizures
• Feeling depressed, anxious, agitated, hostile, aggressive, overly excited or hyperactive, or confused; or having suicidal thoughts

If you are using 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 or others notice possible side effects.

Bupropion can cause drug interactions and shouldn’t be used with certain other drugs or supplements. Be sure your provider knows about everything you take, such as prescription drugs, vitamins, herbs, supplements, and any medicines you take on your own when you need them, like acetaminophen (Tylenol) or aspirin. Also be sure to tell every provider you see that you’re taking bupropion.

Using bupropion along with NRT or varenicline for quitting smoking

There is some consensus that using bupropion along with NRT might increase the odds of quitting. Research on using both varenicline and bupropion at the same time is also being done.

Other prescription drugs used to help people quit tobacco

For those who can’t use either of the US Food and Drug Administration (FDA)-approved drugs to help them quit, or for those who haven’t been able to quit using them, other drugs have shown promise in studies. They’re recommended by the Agency for Healthcare Research and Quality for this kind of use, but have not been approved by the FDA for this purpose and so are used “off-label.” (See Off-label Drug Use for more on this.) These drugs 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

This is an older anti-depressant drug 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. It’s typically started 10 to 28 days before a person stops smoking to allow it to reach a stable level in the body.

Some people have side effects like a fast heart rate, blurred vision, trouble urinating, dry mouth, constipation, weight gain or loss, and low blood pressure when they stand up. The drug can affect a person’s ability to drive or operate machinery, and certain drugs cannot be used along with it.

If you and your health care provider decide to use this drug, be sure your provider and pharmacist know exactly what other drugs you’re taking before you start this medicine. Also be sure you know how to take it and how to taper off it when you are ready to stop. The dose of nortriptyline must be slowly lowered, since the drug cannot be stopped suddenly without the risk of serious effects. People with heart disease should use this drug cautiously. Be sure to tell all your health care providers that you are taking this drug.

Clonidine

Clonidine is another older drug that has been shown to help people quit. It’s FDA-approved to treat high blood pressure. When used to quit smoking, it can be taken as a pill twice a day or worn as a skin patch that’s changed once a week.

If you’re planning to use this drug, be sure your health care provider and pharmacist know exactly what else you’re taking before you start taking it. The most common side effects of clonidine are constipation, dizziness, drowsiness, dry mouth, and unusual tiredness or weakness. There are rarely more severe side effects, such as allergic reactions, a slow heart rate, and very high or very low blood pressure. Your health provider might want to watch your blood pressure while you are on this drug. The drug can affect your ability to drive or operate machinery.

You can start taking clonidine up to 3 days before you quit smoking, but it can also be started the day you quit. 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 drugs being studied to help people quit tobacco

A plant-based drug called cytisine has shown promise in other countries and is now being studied in the United States.

Naltrexone is a drug used to help those with alcohol and opioid abuse disorders. Studies are looking at ways to combine it with varenicline to help people quit smoking, especially people who smoke and are also heavy drinkers.

Also being tested are possible anti-smoking vaccines that are given as injections.

So far these new options seem to be safe, but their effect on smoking cessation has been disappointing.