Smoking Cessation Medications

We all know that smoking can lead to major health issues and that it can worsen other medical conditions. Quitting for good isn’t easy and may take many tries, but the potential for improving your current and future health is worth the effort. And here’s a piece of inspirational information: The Surgeon General says that former smokers now outnumber current smokers, meaning that more than half of all smokers have successfully quit. If you’re trying to quit smoking, there are a variety of prescription and over-the-counter (OTC) medications that can help.

Common Names

Prescription drugs that can help you quit include Zyban (bupropion), Chantix (varenicline), Catapres (clonidine) and Pamelor (nortriptyline). If you want to try OTC treatments, there’s the nicotine patch (Nicoderm CQ, Nicotrol), nicotine gum (Nicorette, Thrive) and nicotine lozenges (Commit, Nicorette). You can also get nicotine nasal spray (Nicotrol NS) and nicotine inhalers (Nicorette, Nicotrol) with a prescription.

How They Work (Method of Action)

Known as nicotine replacement therapy (NRT), the patch, gum, lozenges, nasal spray and inhalers contain small amounts of nicotine and are designed to gradually wean your body off of its dependence on nicotine. This tapering helps decrease the severity of withdrawal symptoms and may help you feel less of a desire to smoke. You can even use the patch with another form of NRT to minimize your symptoms and cravings more effectively, but be sure to talk to your healthcare provider about this first.

Prescription drugs to quit smoking don’t contain nicotine, and some may be used along with NRT, as long as your healthcare provider approves. Zyban and Chantix are FDA-approved to help smoking cessation. While nortriptyline, an older antidepressant, and clonidine, a high blood pressure medication, aren’t FDA-approved for smoking cessation, they are sometimes used if Zyban or Chantix have failed.

Chantix works by blocking nicotine from attaching to nicotine receptors in your brain, eliminating the pleasure from smoking, as well as activating other brain receptors that ease withdrawal symptoms. Zyban decreases your nicotine cravings and withdrawal symptoms by interacting with certain chemicals in your brain. It’s unclear how nortriptyline and clonidine work to curb smoking.

Side Effects and What to Do About Them

Not everyone has side effects and for those who do, many of them go away once your body gets used to the medication.

The most common side effects of NRT include:

• Patch: Skin irritation like redness and/or swelling, headache, dizziness, nausea, vomiting, sleep difficulties and diarrhea. Try using a different brand of patch if it irritates your skin.
• Gum: Dizziness, vomiting, nausea, diarrhea, weakness, sore throat, mouth irritation, irregular heartbeat and jaw pain.
• Lozenges: Sore throat, heartburn, headache, gas, difficulty sleeping, irregular heartbeat, coughing and nausea.
• Nasal spray: Irritated nose, sneezing, throat irritation, runny nose, watery eyes, coughing and a hot feeling in your throat.
• Inhalers: Coughing, sore throat, dizziness, irregular heartbeat, nervousness, runny nose, upset stomach and mouth or throat irritation.

If you experience any of these side effects and they don’t go away, try decreasing your dose or consider using another type of NRT.

The most common side effects with prescription drugs include:

• Zyban: Drowsiness, sleep difficulties, anxiety, dizziness, dry mouth, headache, nausea, vomiting, abdominal pain, tremors, high blood pressure, stuffy nose, loss of appetite, weight loss, constipation, sweating, sore throat and taste changes.
• Chantix: Nausea, gas, constipation, diarrhea, abdominal pain, rash, heartburn, vomiting, dry mouth, abnormal dreams, sleep difficulties, headache, fatigue, seizures, mood changes and joint or muscle pain.
• Nortriptyline: Nausea, drowsiness, fatigue, anxiety, nightmares, appetite changes, rapid heartbeat, constipation, dry mouth, urinary problems, sweating and sexual dysfunction.
• Clonidine: Dry mouth, weakness, fatigue, headache, sexual dysfunction, nervousness, nausea, vomiting and constipation.

User Experiences

After smoking for nearly 20 years, Donna Riverton, 43, decided to use the generic version of the nicotine patch to stop smoking. She used the patches as directed in the packaging instructions, periodically going down in strength and using them for the length of time indicated. Luckily, she didn’t experience any side effects. “The treatment helped me to totally quit,” she says. “I have not smoked in 10 years, six months. There are still times when I am stressed that I consider smoking again, but then I look in the faces of my young children and I don’t want them to pick up the habit or be exposed to secondhand smoke.”

Shaniqua Jones*, 34, has been a smoker for 22 years and has tried several treatments to help her quit. She had an allergic reaction to the adhesive on the nicotine patches that made her skin itch and blister, so she could only use them for a day or two. She also tried Zyban for about a month, but says it did absolutely nothing. “Chantix was the worst,” she says. “I wanted to vomit every time I took it, had horrid nightmares, which were doubly sucky because I get animated in my sleep anyway, and night sweats.” Though she was on Chantix for three months, it didn’t help at all. She does plan to try cinnamon gum and vaping to quit smoking in the future.

Tim Schmidt*, 40, a 23-year smoker, tried Chantix several years ago for the recommended three months, but says it didn’t have any effect on his desire to stop at all. However, he does concede that many medicines don’t seem to have any effect on him. He also experienced vivid dreams and gas while taking Chantix.

Drug Interactions

All of these treatments can have interactions with various other drugs, so it’s important to talk to your healthcare provider or your pharmacist if you’re taking any other prescription or over-the-counter medications, including vitamins and supplements. Chantix may interfere with the efficacy of insulin, asthma medications and blood thinners.

Monoamine oxidase inhibitors (MAOIs), a class of older antidepressants, should be avoided while taking Zyban, as well as Wellbutrin, an antidepressant that also contains bupropion.

Effectiveness and Considerations

Research has shown that using nicotine replacement therapy can almost double your chances of being able to quit smoking. Numerous studies have also shown that Chantix and Zyban are very effective in helping people quit, with Chantix coming out as the most effective treatment in multiple trials.

Nortriptyline is known to be moderately effective, and clonidine has only a limited effect, with more reported side effects, so it’s used less often.

Alternatives

While these treatments can all help with the physical aspect of smoking cessation, consider joining a smoking cessation class, a support group, or getting counseling to help with the emotional and behavioral aspects as well. Using these adjunct treatments increases your chances of quitting successfully.

Hypnotherapy is a non-pharmacological option, and one study found it was more effective in helping smokers quit compared to NRT. Acupuncture is another alternative therapy some people try to help kick the habit. A 2014 Cochrane Review of studies found that although there are indications acupuncture may be effective in the short term to help quit smoking, beyond six months, the evidence is less conclusive.

Overall, alternative treatments for smoking cessation have inconsistent evidence regarding efficacy, according to the National Center for Complementary and Integrative Health.

*Names have been changed to protect privacy