Treatments & Procedures

Medicines to Help Quit Smoking

Why is it so hard to quit smoking?

It is hard to quit smoking because the nicotine in cigarettes, cigars, and other tobacco products gets you hooked and keeps you hooked. Most people try as many as three times to quit before they are able to do so.

Look at quitting smoking as a process instead of a one-time event. That way, if you do slip, you can focus on what to change to prevent future slips. Think of all the benefits you will receive by quitting smoking. If you quit, you will:

  • Prolong your life
  • Improve your health
  • Feel healthier (Smoking can cause coughing, sore throats, and decreased energy level.)
  • Look better (Smoking can cause face wrinkles, stained teeth, and dull skin.)
  • Improve your sense of taste and smell
  • Save money (Most smokers spend about $90 a month on cigarettes.)

People who smoke have a higher risk of getting diabetes. If you already have diabetes, smoking makes managing the disease more difficult. Smoking-related complications of diabetes include retinopathy (eye disease), heart disease, stroke, vascular disease, kidney disease, nerve damage, and/or foot problems.

What treatments are available to help quit smoking?

Some people try to quit on their own. Others try to quit on their own, then decide to go to their doctor. Doctors can offer tips and suggest medicines, both prescription and over-the-counter, to help you quit.

Before taking any medication, make sure your doctor knows what products you are using or thinking of using to quit smoking. Your doctor will also need to know what other medications you are taking. This information helps your doctor determine if any new medicines might interact with other medicines you are already taking.

Over-the-Counter Medicines

Nicotine-based medicines

Over-the-counter medicines that contain nicotine will not remove all cravings but can be very helpful in fighting off cravings. Use these products instead of smoking to gradually reduce your nicotine intake and slowly ease off of nicotine’s addictive effects.

Trying to quit abruptly, rather than slowly reducing the steady dose of nicotine you’ve been giving your body leads to more side effects (withdrawal symptoms). This usually makes quitting a lot harder. Withdrawal symptoms include irritability, headache, and the craving to smoke. Go slow and lower the dose gradually with nicotine-based products until you feel you can resist the cravings on your own. You will still have cravings, but they will be weaker.

It is very important to have social support when you decide to quit, no matter if you use products or not. Support can come from your doctor, counselor, support group, close friend, or a family member.

When considering a nicotine-based product to help you quit, be sure to tell your doctor about any conditions you might have, especially:

  • Asthma or breathing problems
  • Heart or blood vessel disease
  • High blood pressure
  • Stomach ulcer
  • Diabetes mellitus
  • Kidney disease
  • Liver disease
  • Overactive thyroid
  • Pheochromocytoma (PCC)

Over-the-counter treatments are typically used for up to 12 weeks and as part of a quit smoking program. It is important to complete treatment. If you feel you need to use the nicotine-based product for a longer period of time to keep from smoking, talk to your doctor.

Other tips when taking nicotine-based medicines:

  • Decide when you would like to quit smoking. Begin using nicotine-based medicines on your “quit” day even if you are not immediately able to stop smoking.
  • If you are using an over-the-counter nicotine replacement therapy while trying to quit smoking and slip up and have a cigarette, do not stop using the nicotine replacement therapy. Keep using it and keep trying to quit smoking.
  • Tell your doctor about any medicines you are taking or any allergies you have.
  • Do not use the nicotine-based medicines if you are breastfeeding, are pregnant, or think you might be pregnant.
  • Keep this and all medicines out of the reach of children and pets.

Common brand names of the nicotine patch, gum, and lozenge include:

  • Nicorelief® (gum)
  • Nicorette® (gum)
  • NicoDerm® CQ® (patch)
  • Commit® (lozenge)
Transdermal nicotine patch

The patch is worn directly on the skin. Nicotine passes through the skin into your bloodstream. Some brands have patches with different strengths so you can gradually reduce your dosage. Nicotine patches are available without a prescription. If you are not sure what kind of patch to use, ask your doctor.

Always follow the instructions on the box and remember:

  • Patches come in child-resistant pouches. Save the pouch for discarding the used patch.
  • Find a clean and dry area of skin. The upper arm or trunk of the body are good choices. Look for areas that do not have a lot of hair and are clean and smooth (without scars, cuts, burns, or rashes).
  • Before putting on the patch, wash your hands and the area where the patch will be applied. Use plain soap. Make sure the area is completely dry. Do not use products that contain aloe, lanolin, or glycerin as a moisturizer. These ingredients are often found in soaps, hand creams, tanning lotions or oils, bath oils, or insect lotions and sprays. Check the product labels before using. These products can leave a film on the skin, which may cause the patch to fall off.
  • After putting on or taking off the patch, wash your hands with water only.
  • Do not try to adjust the dose of nicotine by cutting the patch into sections.
  • Leave the patch on, even while bathing or swimming. If it falls off, do not try to re-apply it. Use a new one.
  • Remove the patch according to the instructions on the box (usually after 16 to 24 hours).
  • Dispose by folding sticky ends of the patch together and putting in pouch.
  • When applying a new patch, choose a different place than before. Do not use the patch in the same place for at least a week.
  • Do not leave the patch on for longer than directed.
  • Remove the patch if you are going to do heavy exercise. This might cause more nicotine to pass into your bloodstream.
  • If you are unsure how to use the product, ask your doctor or pharmacist to explain.
  • Remove the patch if you are having a magnetic resonance imaging (MRI) scan. Nicotine patches contain aluminum.
  • If you have vivid dreams or other sleep problems, try removing the patch at bedtime and applying a new one in the morning.

Common side effects of the nicotine patch include:

  • Increased appetite
  • Mild headache
  • Irritation at the site of the patch, including itching, burning, or redness

There are other common or more serious side effects. Please carefully read the information that comes with the product. Contact your doctor if you have any questions.

Nicotine gum

Nicotine gum, like the patch, is a systemic way to receive nicotine. This means that the nicotine in the gum passes from the lining of your mouth right into your bloodstream. Like the patch, you will decrease the dosage during the recommended timeframe (usually 12 weeks or sooner) if you are able to resist cravings on your own. Nicotine gum is sold without a prescription.

Always follow the instructions on the box and remember:

  • Use nicotine gum only when you feel the urge to smoke.
  • Slowly chew the gum until you begin to taste it or feel a tingling sensation in your mouth. Then stop chewing and park it between your cheek and gum. This helps release the nicotine. When the taste or tingling is almost gone, repeat these two steps for 30 minutes.
  • Use only one piece at a time.
  • Do not drink beverages (for example, soft drinks, tea, coffee, and fruit juices) or eat food 15 minutes before or while chewing the gum.
  • Gradually decrease the number of pieces of gum you chew per day, until you reach three to six pieces per day. Some people can do this in less than 12 weeks. Do not chew more than twenty-four pieces in one day.
  • Try to have the nicotine gum handy at all times. You might try hard candy or using regular gum, if the nicotine gum is not available.
  • Nicotine gum can be difficult to use if you have dentures.

Common side effects of nicotine gum:

  • Belching (burping), gas, or heartburn
  • Increased appetite
  • Mild headache
  • Watery mouth
  • Jaw or muscle pain or fatigue
  • Sore mouth or throat
  • Nausea
  • Hiccups

There are other common or more serious side effects. Please carefully read the information that comes with the product. Contact your doctor if you have any questions.

Nicotine lozenge

A nicotine lozenge, like the patch and gum, is a systemic way to receive nicotine. This means that the nicotine in the lozenge passes from the lining of your mouth right into your bloodstream.

Always follow the instructions on the box and remember:

  • Place the lozenge in your mouth; wait until it dissolves completely; and move it around from time to time without chewing. It takes around 20 to 30 minutes to dissolve.
  • Do not take more than one lozenge at a time or continuously use one lozenge after the other, this can cause hiccups, heartburn, or nausea.
  • Do not eat or drink 15 minutes prior to, during, or after use.
  • Do not use more than five lozenges in 6 hours or more than twenty lozenges in 24 hours.

Prescription Medicines

Nicotine nasal spray

Nicotine nasal spray is available only by prescription. Like the patch and the gum, the amount taken is gradually decreased during a period of 12 weeks. It is to be used, like the gum and the patch, as part of a program that also includes support, education, and counseling.

Nicotrol NS® is one brand of nicotine nasal spray.

Always follow the instructions on the prescription label and remember:

  • Blow your nose prior to use.
  • Gradually reduce your dose of nasal spray by skipping doses or using only half the usual amount.
  • Write down the time you take the nasal spray and how much you take. This might be very useful as you reduce your dose.

Common side effects of nicotine nasal spray include:

  • Back pain
  • Constipation
  • Coughing
  • Indigestion or nausea
  • Runny nose
  • Sneezing
  • Watery eyes
  • Headache
  • A burning feeling in the back of the throat or nose

The nicotine nasal spray is not recommended for people with reactive airway disorders such as asthma. In addition, caution is urged in patients with chronic nasal disorders.

There are other common or more serious side effects. Please carefully read the information page that comes with the product. Contact your doctor if you have any questions.

Nicotine inhalant

A nicotine inhalant -- available only by prescription -- used for up to 6 months (initial treatment period up to 12 weeks followed by gradual reduction period of up to 12 weeks) can be part of a quit smoking program. When the inhaler is used, nicotine passes from the lining of the mouth and throat (not the lungs) into the bloodstream. Like other nicotine products, you will decrease the dosage during the recommended timeframe (usually several weeks) or until you are able to resist cravings on your own.

Nicotrol Inhaler® is one brand name of nicotine inhalant.

Always follow the instructions on the box and remember:

  • Store the inhaler in a dry area at room temperature not to exceed 77° F or 25° C.
  • Write down the time you take the inhalant and how much you take. This might be very useful as you reduce your dose.
  • The normal first dose is between six and sixteen cartridges per day.

Common side effects of nicotine inhalants include:

  • Coughing
  • Indigestion
  • Mouth and throat irritation
  • Stuffy nose or runny nose

There are other common or more serious side effects. Please carefully read the information that comes with the product. Contact your doctor if you have any questions.

Bupropion

Bupropion is more commonly known by the brand names of Zyban® or Wellbutrin®. Zyban is specifically indicated for quitting smoking. It is not a nicotine-based medicine; it is an antidepressant that is only available by prescription. It is prescribed along with counseling and support to help with quitting smoking. Bupropion might also be used to treat major depressive disorders. It usually takes 2 weeks for bupropion to take effect, so plan to quit smoking 2 weeks after beginning the treatment.

Before considering bupropion, tell your doctor if you have a history of seizure disorder, bulimia, or anorexia nervosa.

Bupropion is available in tablets. The tablets are to be swallowed whole, not crushed, divided, or altered in any other way. Individual prescription strengths might vary, so if you are taking bupropion, follow the directions on the label. Ask your doctor or pharmacist any questions you have about how to take it, when to take it, any potential side effects, and the length of treatment.

Common side effects of bupropion include:

  • Dry mouth
  • Sweating
  • Insomnia
  • Rash
  • Headache
  • Dizziness
  • Anxiety
  • Restlessness
  • Irritability
  • Indigestion
  • Decreased appetite

There are other common or more serious side effects. Please carefully read the information that comes with the product. Contact your doctor if you have any questions.

Do not take bupropion if you have taken a monoamine oxidase inhibitor (MAOI) within the last 14 days. Monoamine oxidase inhibitors are used to treat depression. Some examples include: tranylcypromine (Parnate®), phenelzine (Nardil®), and isocarboxazid (Marplan®). There are several products that might interact with bupropion, Tell your doctor about any over-the-counter and/or prescription medicines and any herbal supplements you are taking.

While taking bupropion, immediately report any psychological changes (for example, new bouts of depression) to your doctor.

Varenicline (Chantix®)

Varenicline, also known by the brand name Chantix®, is a prescription medication that does not contain nicotine. This medicine helps reduce both the addictive and withdrawal effects of nicotine. It is recommended to set a quit date one week after starting varenicline therapy. Typically, this medication is taken for at least 12 weeks along with counseling to help quit smoking. If you have stopped smoking, another 12 weeks of varenicline might be prescribed. If you have not stopped smoking after the first 12 weeks, stop taking this medication and return to your doctor for advice. Varenicline should be taken with food and a full glass (8 ounces) of water.

Before taking varenicline, tell your healthcare professional if you drink alcohol, have a history of seizures, or if you have ever had depression or other mental health problems.

Varenicline can interact with over-the-counter and prescription medicines especially insulin, blood thinners, and asthma medications as well as with certain herbal supplements. Please tell your doctor all the medications and products you are taking.

Contact your doctor immediately if you experience any psychological or behavioral changes (for example, new onset depression, nervousness or agitation, hostility, aggressive behavior, thoughts of suicide) while taking varenicline.

Varenicline may change the way people react to alcohol; therefore, decrease the amount of alcoholic beverages you drink during treatment until you know how it affects your ability to tolerate alcohol.

Common side effects of varenicline include:

  • Nausea, which may lessen over time
  • Headache
  • Insomnia

There are other common or more serious side effects. Please carefully read the information that comes with the product. Contact your doctor if you have any questions.

How could research benefit smokers who want to quit?

Researchers are evaluating different forms of varenicline for quitting smoking. Medications that affect receptors in the central nervous system, such as topiramate (Topamax®) and memantine (Namenda®), are currently being tested in clinical trials as aids to help quit smoking.

In addition, a clinical trial is studying a form of electronic cigarette that does not contain nicotine given along with counseling as an early method to reduce or quit smoking.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/20/2015…#13394