Prescription drugs are also available to help smokers quit. Some can be used along with nicotine replacement therapy (NRT), and some must be started before your planned Quit Day. Talk to your doctor if you are interested in using medicine to help you quit smoking. These are only available with a prescription.
Bupropion (Zyban®)
Bupropion (Zyban® or Wellbutrin®) is a prescription anti-depressant in an extended-release form that reduces 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 is started a week or 2 weeks before you quit smoking. The usual dosage is one or two 150 mg tablets per day.
If you are able to quit smoking after 7 to 12 weeks of bupropion your doctor may have you take it for some time after to help you stay quit. Keep up with your other support systems during this time and for a few months after you quit.
This drug should not be taken if you have ever had seizures (it can cause or worsen seizures), heavy alcohol use, serious head injury, bipolar (manic-depressive) illness, or anorexia or bulimia (eating disorders).
Reported side effects of bupropion have included dry mouth, trouble sleeping, appetite changes, agitation, constipation, and headaches. People using bupropion should call their doctors if they feel depressed or start thinking of suicide. They should also call their doctors for changes such as feeling anxious, agitated, hostile, aggressive, overly excited and hyperactive, or not being able to sleep. These are rare, but can happen more often near the start of treatment or after a dose change.
Some doctors may recommend combination therapy for heavily addicted smokers, such as using bupropion along with a nicotine patch and/or a short-acting form of NRT (such as gum or lozenges). The combination has been found to work better for some people than using any one part alone.
Varenicline (Chantix®)
Varenicline (Chantix®) is a newer 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 pleasurable effects a person gets from smoking, and it reduces the symptoms of nicotine withdrawal. Varenicline should be started a week before your Quit Day.
Several studies have shown taking varenicline can more than double the chances of quitting smoking when compared to taking no medicines at all. Some studies have also found it may work better than bupropion, at least in the short term.
Varenicline comes in pill form and is taken after meals, with a full glass of water. The daily dose increases over the first 8 days it is taken. The dose starts at one 0.5 mg pill a day for the first 3 days, then the 0.5 mg pill twice a day for the next 4 days. At the start of the second week, the dose is raised to 1 mg each morning and evening. For people who have problems with the higher dose, a lower dose may be used during the quit effort. Varenicline is given for 12 weeks, but people who quit during that time may get another 12 weeks of treatment to boost their chance of staying quit. Keep up with your other support systems during this time and for a few months after you quit.
Reported side effects of varenicline have included headaches, nausea, vomiting, trouble sleeping, unusual dreams, flatulence (gas), and changes in taste. People with heart disease may have a higher risk of heart attacks while on varenicline. There have also been reports of depressed mood, thoughts of suicide, attempted suicide, and changes in behavior in people taking varenicline. People who have these problems should contact their doctors right away. Reports of these side effects have been rare, but they can be serious when they do happen. Most people who take varenicline tolerate it well.
Not much research has been done to find out if varenicline is safe to use at the same time as nicotine replacement therapy (NRT) products. One study has suggested that using varenicline along with NRT is well-tolerated and safe, even though more people taking both drugs had side effects than those taking only one. The company that makes varenicline had already noted that people who used the drug along with NRT had more side effects such as nausea and headaches. More research is needed.
“Off-label” drugs to help smokers quit
For those who cannot use any of the FDA-approved drugs for helping smokers quit, or for those who have not been able to quit using them, there are other drugs that have shown promise in research studies. They are 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 our document called Off Label Drug Use for more information.) These drugs are only available with a prescription and are not recommended for pregnant smokers, teens, or people who smoke less than 10 cigarettes per day.
Nortriptyline
This is an older anti-depressant drug. When used in groups of smokers, it has been found to double the chances of success in quitting smoking when compared to those taking no medicine. It is started 10 to 28 days before you stop 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 impair your ability to drive or operate machinery, and there are certain drugs that cannot be used along with it.
Be sure your doctor and pharmacist know exactly what else you are taking before you start this medicine. Also be sure you know how to take it and how to taper it down 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. The drug must be used with caution in people with heart disease. While you are taking it, be sure to tell any doctor you visit that you are taking the drug.
Clonidine
Clonidine is another older drug. It is FDA approved to treat high blood pressure. When used for smoking cessation, it can be given as a pill twice a day or as a once-a-week skin patch. In one study of heavy smokers who had failed in previous quit attempts, the group treated with clonidine was twice as likely to succeed in quitting smoking as the control group (which was given a fake pill) at the end of 4 weeks.
Be sure your doctor and pharmacist know exactly what else you are taking before you start this medicine. 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 doctor may want to watch your blood pressure while you are on this drug. The drug can impair your ability to drive or operate machinery
Clonidine can be started up to 3 days before you quit smoking, but can also be started the day you quit. Like nortriptyline, it shouldn’t be stopped suddenly. The dose must be lowered over 2 to 4 days to prevent a rapid increase in blood pressure, agitation, confusion, or tremors
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