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Smoking cessation medications

Alternative Names

Smoking cessation - medications; Smokeless tobacco - medications; Medications for stopping tobacco

Information

Your health care provider can prescribe medicines to help you quit tobacco use. These medicines do not contain nicotine. They work in a different way than nicotine patches, gums, sprays or lozenges . They are not habit-forming.

These medicines can:

  • Help with the craving for tobacco.
  • Help you with withdrawal symptoms.
  • Keep you from starting to use tobacco again.

Like other treatments, these medicines work best when they are part of a program that includes:

BUPROPION (Zyban)

Bupropion is a pill that may cut down your craving for tobacco.

Bupropion is also used for people with depression. It will help with quitting tobacco even if you do not have problems with depression. It is not fully clear how bupropion helps with tobacco cravings.

Bupropion should not be used for people who:

  • Are under age 18.
  • Are pregnant.
  • Have a history of medical problems such seizures, kidney failure, heavy alcohol use, eating disorders, bipolar or manic depressive illness, or a serious head injury.

How to take it:

  • Start bupropion 1 - 2 weeks before you stop smoking. You can take it for 6 months to a year.
  • The most common dose is a 150 mg tablet once or twice per day.
  • If you need help with cravings when first quitting, you may taking bupropion along with nicotine patches, gums, or lozenges. Ask your doctor if this is OK for you.

Side effects of this medicine may include:

  • Dry mouth.
  • Problems sleeping. Try taking the second dose in the afternoon if you have this problem (You must take it least 8 hours after the first dose.)
  • Stop taking this medicine right away if you have changes in behavior (such as anger, agitation, depressed mood, thoughts of suicide, or attempted suicide).

VARENICLINE (CHANTIX)

Varenicline (Chantix) helps with the craving for nicotine and withdrawal symptoms. It works in the brain to reduce the physical effects of nicotine. This means that even if you start smoking again after quitting, you will not get as much pleasure from it when you are taking this drug.

How to take it:

  • Start taking this medicine 1 week before you quit cigarettes. You will take it for 12 - 24 weeks.
  • Take it after meals with a full glass of water.
  • Your doctor will tell you how to take this medicine. Most people take one 0.5 mg pill a day at first. By the end of the second week, you will likely be taking a 1 mg pill twice a day.
  • Do not be combine this drug with nicotine patches, gums, sprays or lozenges.
  • Children under age 18 should avoid this drug.

Most people tolerate varenicline well. Side effects are not common, but can include the following if they do occur:

  • Headaches, problems sleeping, sleepiness, and strange dreams.
  • Constipation, intestinal gas, nausea, and changes in taste.
  • Depressed mood, thoughts of suicide and attempted suicide. Call your doctor right away if you have any of these symptoms.

NOTE: Use of this medicine is linked to an increased risk of heart attack and stroke.

OTHER MEDICINES

The following medicines may be helpful in quitting smoking when other treatments have not worked. The benefits are less consistent, so they are considered "second-line" treatment.

  • Clonidine (Catapres) is normally used to treat high blood pressure. It may help smokers with quitting when it is started before quitting, and comes either as a pill or patch.
  • Nortriptyline is another antidepressant, It may help with quitting when it is started 10 - 28 days before quitting.

References

American Cancer Society. Guide to Quitting Smoking. January 17, 2013. http://www.cancer.org/acs/groups/cid/documents/webcontent/002971-pdf.pdf  (accessed February 4, 2013).

Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2012 Apr 18;4:CD006103. doi: 10.1002/14651858.CD006103.pub6.

Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services Public Health Service, May 2008. http://www.ncbi.nlm.nih.gov/books/NBK63952/  (accessed February 4, 2013).

George TP. Nicotine and tobacco. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 31.

Hays JT, Ebbert JO, Sood A. Treating tobacco dependence in light of the 2008 U.S. Department of Health and Human Services clinical practice guideline. Mayo Clin Proc. 2009;84:730-735.

Singh S, Loke YK, Spangler JG, Furberg CD. Risk of serious adverse cardiovascular events associated with varenicline: a systematic review and meta-analysis. CMAJ. 2011 Jul 4: 1-8.

Updated: 2/4/2013

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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