Prescription Drugs to Help You Quit Smoking
Prescription drugs to help you quit smoking
There are some prescription drugs that have been shown to help smokers quit. Some can be used along with nicotine replacement therapy (NRT). Some must be started weeks before the day you plan to quit.
Talk to your health care provider if you want to use medicine to help you quit smoking. You’ll need a prescription these drugs.
Smokers who are significantly dependent on nicotine should consider nicotine replacement or drug therapy to help them quit. Signs of severe dependence are:
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, and it reduces the symptoms of nicotine withdrawal. Several studies have shown varenicline can increase the chance of quitting smoking when compared to taking no medicines at all. Some studies have found it works better than bupropion, at least in the short term.
Varenicline should be started 1 or 2 weeks before your Quit Day. It 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’s 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 in the 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 chances of staying quit. It’s important to keep up with other support systems during this time and for at least a few months after quitting.
Tell your doctor about any medical conditions and allergies before you start varenicline.
Side effects of varenicline
Reported side effects have included:
- Trouble sleeping and unusual dreams
- Changes in taste
Varenicline should not be used during pregnancy.
Using varenicline along with NRT or bupropion for quitting smoking
Not much research has been done to find out if varenicline is safe to use 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 more research is needed.
Research on using both varenicline and bupropion at the same time is ongoing. So far there’s no clear benefit to combining the drugs.
Bupropion may be called the brand names Zyban®, Wellbutrin®, or Aplenzin®. It’s a prescription anti-depressant 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 able to stay quit after 7 to 12 weeks of bupropion your provider may have you keep taking it for some time afterward to help keep 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
- Serious head injury
- Bipolar (manic-depressive) illness
- Anorexia or bulimia (eating disorders)
Bupropion should not be used during pregnancy. 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).
Side effects of bupropion
The most common reported side effects of bupropion include
- Dry mouth
- Trouble sleeping and nightmares
People using bupropion should call their health care providers if they feel depressed or start thinking of suicide. They should also call their health care providers for changes such as feeling anxious, agitated, hostile, aggressive, overly excited and hyperactive, confused, or unable to sleep. These are rare, but can happen, often near the start of treatment or after a dose change.
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 Tylenol or Aspirin. Also be sure to tell every doctor you see that you’re taking bupropion.
Using bupropion along with NRT for quitting smoking
Some health care providers 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 (like gum or lozenges). Combinations should only be used if a health care provider is monitoring you.
If you plan to use a prescription drug to quit smoking, 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.
Other prescription drugs used to help smokers quit
For those who can’t use any of the FDA-approved drugs for helping smokers quit, or for those who haven’t been able to quit using them, other drugs have shown promise in research 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 smokers, teens, or people who smoke less than 10 cigarettes per day.
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 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 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 cautiously in people with heart disease. While you’re taking it, be sure to tell all your health care providers that you are taking this drug.
Clonidine is another older drug that has been shown to help people quit. It’s 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.
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 provider may want to watch your blood pressure while you are on this drug. The drug can affect 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. 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.
Other drugs being studied to help smokers quit
Other medicines such as naltrexone, which comes as a pill, are being studied. It’s being used along with other treatments (like bupropion and NRT) to see if it can help reduce cravings. But the newest analysis of previous studies suggested it wasn’t helpful.
A drug called cytisine was recently tested in Poland and found to help reduce smoking. About 8% of smokers still didn’t smoke after a year, compared to about 2% of those on placebo. This drug is being studied in the United States, although most studies posted looked at rodents rather than people. Another drug being tested is sazetidine-A, but again, most published studies to date are on rodents.
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.
Agency for Healthcare Research and Quality. Clinical Guidelines for Prescribing Pharmacotherapy for Smoking Cessation. December 2012. Accessed at www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/prescrib.html on January 14, 2016.
Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013 May 31;5:CD009329.
Ebbert JO, Hatsukami DK, Croghan IT, et al. Combination varenicline and bupropion SR for tobacco-dependence treatment in cigarette smokers: a randomized trial. JAMA. 2014;311(2):155-163.
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service; 2008. Accessed at www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf on January 30, 2014.
Gibbons RD, Mann JJ. Varenicline, smoking cessation, and neuropsychiatric adverse events. Am J Psychiatry. 2013;170:1460-1467.
Henningfield JE, Fant RV, Buchhalter AR, Stitzer ML. Pharmacotherapy for nicotine dependence. CA Cancer J Clin. 2005;55:281-299.
Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2014;1:CD000031.
Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2007;(1):CD000031.
Koegelenberg CF, Noor F, Bateman ED, et al. Efficacy of varenicline combined with nicotine replacement therapy vs varenicline alone for smoking cessation: a randomized clinical trial. JAMA. 2014;312(2):155-161.
Manufacturer’s product information. January 2012. Accessed at http://us.gsk.com/products/assets/us_zyban.pdf on February 6, 2014.
Manufacturer’s product information. December 2012. Accessed at http://labeling.pfizer.com/ShowLabeling.aspx?id=557 on February 6, 2014
McDonough M. Update on medicines for smoking cessation. Aust Prescr. 2015;38(4):106-111.
West R, Zatonski W, Cedzynska M, et al. Placebo-controlled trial of cytisine for smoking cessation. N Engl J Med. 2011;365(13):1193-1200.
Last Medical Review: May 6, 2016 Last Revised: May 6, 2016