Quitting smoking is not easy, and most people try many times before they are able to quit for good. There are many ways to quit smoking. For example, some are able to stop “cold turkey,” by taking part in the Great American Smokeout®, or by using other methods.

No matter what methods they use, they need more than one approach. They must deal with the physical symptoms caused by withdrawal from nicotine, which usually only last a few days to a couple of weeks. They also need to deal with the emotional, psychological, and mental dependence. People who quit for good find ways to deal with pressure, stress, and emotional pain without smoking. The mental/psychological craving can cause relapse even years later – that’s how addictive nicotine is.

There’s no single best way to quit. Quitting for good may mean using many methods, including step-by-step manuals, self-help groups, counseling, toll-free telephone-based counseling programs, online support, and/or using nicotine replacement therapies or other medicines (see the next questions). Smokers may also need to make changes in their daily routines to help them break their smoking habits. Some may find long-term support such as Nicotine Anonymous helpful. To improve your chances of success, try to use 2 or more of these methods to help you quit.

What are nicotine replacement therapies?

Nicotine replacement therapies (NRTs) are medicines that help decrease or stop a smoker’s withdrawal symptoms by giving controlled doses of nicotine without the other harmful chemicals of cigarette smoke. NRTs are sold as patches, gums, inhalers, nasal sprays, or lozenges. The Food and Drug Administration (FDA) has approved all of these products to help people quit smoking. You can buy patches, gums, and lozenges over the counter, but you need a prescription for inhalers and nasal sprays.

These products work by helping smokers manage their physical responses as they quit. For best results, smokers should use NRTs along with behavioral change programs that are designed to help smokers break their psychological (mental) dependence on cigarettes. For more information on such programs, call your American Cancer Society at 1-800-227-2345.

Not everyone can use NRT. People with certain medical conditions and pregnant women should use it only with a doctor’s supervision. It is always a good idea to get your doctor’s input and support when you decide to quit smoking.

The best time to start NRT is when you begin to try to quit. Many smokers ask if it is possible to start using NRT while they are still smoking. There is some research on smokers using NRT while still smoking, but the results are still not clear enough to say for certain if this might pose a danger to your health. The most important thing is to make sure that you are not overdosing on nicotine, which can affect your heart and blood circulation. It is safest to be under a doctor’s care if you wish to try smoking and using NRT while you are tapering off cigarette smoking.

For more information, see our document called Guide to Quitting Smoking.

Are there other medicines or vaccines to help smokers quit?

Yes. Some medicines that don’t contain nicotine have already been approved to help quit smoking.

Bupropion (Wellbutrin®) was first used as an anti-depressant, and later approved by the FDA to help people quit smoking (under the brand name Zyban®). This medicine does not contain nicotine and you need a prescription for it. It affects chemicals in the brain that are related to nicotine craving. It can be used alone or together with nicotine replacement therapy (NRT). Unlike NRT, you start taking it 1 or 2 weeks before you stop smoking.

Newer medicines may help smokers (or former smokers) by stopping them from getting physical pleasure from smoking. The medicines seem to work by stopping nicotine from stimulating the brain. They may work by blocking the brain receptors that nicotine normally attaches to, or by keeping nicotine from reaching the brain altogether (as in the case of the vaccines; see below).

One such medicine, varenicline (Chantix®), is FDA-approved for help with quitting. Varenicline is a pill that is started at a low dose before your quit date, then the dose is increased slowly over the next few days. Once in the body, it attaches to nicotine receptors in the brain, reducing the pleasurable effects of smoking and helping to reduce nicotine withdrawal symptoms. Many studies have shown varenicline can more than double the chances of quitting smoking. Since varenicline is a newer drug, research has not been done yet to find out if it is safe to use along with NRT. But the company that makes varenicline noted that people who used the drug along with NRT had more side effects such as nausea and headaches.

For people who have not been able to quit smoking using NRT, bupropion, or varenicline, or who can’t use these drugs, some doctors prescribe older medicines that have been approved by the FDA for uses other than quitting smoking. For instance, nortriptyline is a drug used to treat depression and clonidine is used to treat high blood pressure. Both of these drugs may be used to help a person quit smoking, but both have restrictions on who can safely use them. People taking them need medical monitoring because of rare but serious side effects. Still, studies have shown that they can make it easier for some people to quit smoking, even though they have not been approved by the FDA for that purpose.

Other medicines still being studied include naltrexone, which also comes as a pill. It is being used along with other medicines such as bupropion and NRT to see if it can reduce cravings. Another drug called cytisine was recently tested in Poland and found to help reduce smoking when compared to placebo. About 8% of smokers remained quit after a year, compared to about 2% of those on placebo. Also still being tested are anti-smoking vaccines that are given as a series of shots. Tests of these new treatments have been promising. So far they seem to be safe, but larger studies are needed to show these treatments work before the FDA can approve them for this use. Large studies of these treatments are now under way.

It is not likely that any one of these drugs will work in every person. That’s why using different quitting aids at the same time is still the best way to increase your chances of success. For more information on quitting and medicines that can be used, see our document called Guide to Quitting Smoking.