Should I take medicine to quit smoking?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Quitting smoking is hard because your body becomes addicted to the nicotine in tobacco. Giving it up is more than just kicking a bad habit. Your body has to stop craving the nicotine. If you have decided to quit smoking, you may want to think about taking medicine that can make it easier to stop. You can also use this information if you want to quit using tobacco products such as chew or snuff, or if you smoke cigars or pipes.

Consider the following when making your decision:

• Studies show that using medicines to quit smoking can double your chance of success. Because of that, experts recommend that all smokers take medicines to help when they try to quit.
• The reason many people go back to smoking is because of nicotine withdrawal symptoms. Medicines can help relieve these symptoms.
• Some insurance companies will pay for all or part of the cost of medicines used to quit smoking.
• The medicines used most commonly to quit smoking have few side effects. Becoming addicted to the medicines is rare.
• Quitting smoking can be stressful, and you may have to do more than just take medicine. Success also depends on getting ready, getting support, learning how to get along without tobacco, and being prepared for setbacks.

Medical Information

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What are the medicines?

Your doctor may prescribe varenicline (Chantix) or bupropion (Zyban) to help you cope with cravings for tobacco. These medicines are pills and do not contain nicotine.

Varenicline acts on areas in the brain affected by nicotine. It helps with craving and withdrawal symptoms. Varenicline also blocks the effects of nicotine from tobacco. If you start smoking again while you are taking varenicline, the medicine lowers the sense of satisfaction you get from smoking, improving the chances that you will quit. Some studies have found that varenicline works better than bupropion.¹ But how well one medicine works for others may be different from how well it works for you. You may need to try different medicines to find one that works for you.

You start taking varenicline about a week before you quit smoking, and you take it for a total of 12 to 24 weeks. You take varenicline 2 times a day, after meals. Unlike bupropion, varenicline may not prevent weight gain.

The way bupropion helps people cope with cravings is not entirely known. Bupropion can help balance chemicals in your brain and reduce your withdrawal symptoms. Doctors also prescribe bupropion (under the brand name Wellbutrin) to treat depression. But it can help you stop smoking even if you do not have depression.

You start taking bupropion daily about 1 to 2 weeks before you quit smoking. This builds up the level of medicine in your body. You keep taking bupropion for 7 to 12 weeks after you stop using tobacco. You can take it for as long as 6 months to a year.

People who take bupropion to quit smoking tend to avoid the weight gain associated with quitting smoking. But this is temporary. You may gain weight after you stop taking bupropion.

There are two other medicines you can try if varenicline and bupropion do not work or you cannot take them. These are nortriptyline (Aventyl, Pamelor) and clonidine (Catapres).

What are the risks of taking a medicine to quit smoking?

The most common side effects of varenicline include nausea, increased dreaming, and constipation. More people had side effects such as nausea, headache, and dizziness when they used both varenicline and a nicotine patch.

Some people taking bupropion reported dry mouth and trouble sleeping. There is a small risk of having seizures when you use bupropion. The risk increases if you have had seizures in the past before you used bupropion.

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. When you stop smoking, there may be a change in how other medicines work for you.

Using both medicine and professional counseling often works best to quit smoking. If you need more information on tips for quitting, see the Strategies and Skills for Quitting section of the topic Quitting Tobacco Use.

Your Information

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Your choices are:

• Take medicine your doctor prescribes to ease the symptoms of nicotine withdrawal.
• Use over-the-counter nicotine replacement therapy.
• Do not take any medicine.
• Get counseling even if you do not take medicines.

The decision whether to take medicine to quit smoking takes into account your personal feelings and the medical facts.

Deciding about medicines to quit smoking

Reasons to take medicine to quit smoking	Reasons not to take medicine to quit smoking
You smoke more than 10 cigarettes a day. You have withdrawal symptoms—such as grouchy behavior, having trouble staying focused on what you're doing, or hunger—when you go too long without a cigarette. You have tried to quit in the past without using medicine and started smoking again. Are there other reasons you might want to take medicine?	You smoke fewer than 10 cigarettes a day. You are younger than 18. You are pregnant or breast-feeding. Are there other reasons you might not want to take medicine?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking medicine to quit smoking. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I'm ready to quit smoking.	Yes	No	Unsure
I've tried other ways to quit, and they didn't work.	Yes	No	NA*
I'm ready to ask my doctor about prescription and over-the-counter medicines.	Yes	No	Unsure
I think I need help with nicotine withdrawal symptoms, such as grouchy behavior and being nervous, hungry, or not staying focused on what I'm doing.	Yes	No	Unsure
I'm ready to find out about using support such as professional counseling.	Yes	No	Unsure

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medicine.

Check the box below that represents your overall impression about your decision.

Leaning toward using medicine to quit smoking

Leaning toward NOT using medicine to quit smoking

Advisory

The U.S. Food and Drug Administration (FDA) has issued an advisory to patients, families, and health professionals to closely monitor adults and children taking antidepressants (such as bupropion) for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.

The FDA also advises that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania. Studies have not shown these problems to happen with bupropion. The FDA has not recommended that people stop using antidepressants, but simply to monitor those taking the medicines and, if concerns arise, to contact a health professional.

Return to the topic Quitting Tobacco Use.

References

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Citations

1. Varenicline (Chantix) for tobacco dependence (2006). Medical Letter on Drugs and Therapeutics, 48(1241/1242): 66–68.

Credits

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Author	Debby Golonka, MPH
Author	Caroline Rea, RN, BS, MS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	John Hughes, MD - Psychiatry
Last Updated	July 24, 2007