- Quit Tobacco Prescription | Smoking Cessation Drugs
- Varenicline (Chantix)
- Side effects of varenicline
- Using varenicline along with NRT or bupropion for quitting smoking
- Bupropion (Zyban)
- Side effects of bupropion
- Using bupropion along with NRT or varenicline for quitting smoking
- Other prescription drugs used to help people quit tobacco
- Other drugs being studied to help people quit tobacco
- Bupropion | Zyban | Stop Smoking Medicine
- High blood pressure
- Bupropion weight loss
- Bupropion overdose
- Stop smoking treatments
- Where to get it and how to use it
- Who can use it
- Possible side effects
- Possible side effects
Quit Tobacco Prescription | Smoking Cessation Drugs
There are prescription drugs that have been shown to help people quit tobacco. Some can be used along with nicotine replacement therapy (NRT). You often need to start taking them in the weeks before your Quit Day (the day you plan to quit).
People who are significantly dependent on nicotine should consider nicotine replacement and/or drug therapy to help them quit. Signs of severe nicotine dependence in people who smoke include:
- Smoking more than 1 pack a day
- Smoking within 5 minutes of waking up
- Smoking even while sick
- Waking up at night to smoke
- Smoking to ease symptoms of withdrawal
The more of these that apply, the more serious the dependence.
Talk to your health care provider if you think you might want to use one of these drugs to help you quit tobacco. You’ll need a prescription. It's also a good idea to talk to your health insurance about coverage for these medications.
If you plan to use a prescription drug to quit tobacco, 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.
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.
- It reduces the symptoms of nicotine withdrawal.
For people trying to quit smokeless tobacco, several studies have shown varenicline can increase their chance of quitting when compared to taking no medicines at all, at least in the short term. (Some studies have also found NRT lozenges can help.)
You typically start taking varenicline (a pill) about a month to a week before your Quit Day. Take it after meals, with a full glass of water. The daily dose increases over the first 8 days you take it. If you have problems with the higher doses, a lower dose may be used while you try to quit.
Typically, 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 off tobacco. It’s important to keep up with other support systems during this time and for at least a few months after quitting.
Tell your provider about any medical conditions and allergies you have before you start varenicline, including if you might be pregnant.
Side effects of varenicline
Reported side effects have included:
- Trouble sleeping, unusual dreams, or sleepwalking
- Changes in taste
- Skin rashes
- Heart or blood vessel problems (mostly in people who already have these problems)
- Mood or behavior changes, such as depression, hallucinations, delusions, aggression, hostility, agitation, anxiety, panic, or even suicidal thoughts
Talk to your health care team about what to expect while taking this drug, and what to do if you or others notice possible side effects. Be sure to let your provider know if you’ve ever had depression or other mental health problems, or if you start feeling depressed or have thoughts about suicide.
Using varenicline along with NRT or bupropion for quitting smoking
Research is being done to find out if varenicline can be used 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 others have found this has no long-term benefit in helping people quit. More research is needed.
Research on using both varenicline and bupropion at the same time is also being done. While there may be a benefit to combining the drugs vs. taking only varenicline, more research is needed to understand if this could cause more severe side effects.
Bupropion also may be called by the brand names Zyban, Wellbutrin, or Aplenzin. It’s a prescription antidepressant 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 still not using tobacco after taking bupropion for 7 to 12 weeks, your provider may have you keep taking it for some time afterward to help stop 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
- A serious head injury
- Bipolar (manic-depressive) illness
- Anorexia or bulimia (eating disorders)
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).
Tell your doctor about any medical conditions and allergies you have before you start bupropion, including if you might be pregnant.
Side effects of bupropion
Reported side effects of bupropion include:
- Dry mouth
- Stuffy nose
- Trouble sleeping and nightmares
- High blood pressure
- Feeling depressed, anxious, agitated, hostile, aggressive, overly excited or hyperactive, or confused; or having suicidal thoughts
If you are using bupropion, call your health care provider if you feel depressed or start thinking of suicide. Also be sure to ask what to expect while taking this drug, and what to do if you or others notice possible side effects.
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, acetaminophen (Tylenol) or aspirin. Also be sure to tell every provider you see that you’re taking bupropion.
Using bupropion along with NRT or varenicline for quitting smoking
There is some consensus that using bupropion along with NRT might increase the odds of quitting. Research on using both varenicline and bupropion at the same time is also being done.
Other prescription drugs used to help people quit tobacco
For those who can’t use either of the US Food and Drug Administration (FDA)-approved drugs to help them quit, or for those who haven’t been able to quit using them, other drugs have shown promise in 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 women, teens, or people who smoke fewer than 10 cigarettes a 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 typically 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 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 off it 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. People with heart disease should use this drug cautiously. 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 to quit smoking, it can be taken as a pill twice a day or worn as a skin patch that’s changed once a week.
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 health provider might want to watch your blood pressure while you are on this drug. The drug can affect your ability to drive or operate machinery.
You can start taking clonidine up to 3 days before you quit smoking, but it can also be started the day you quit. It shouldn’t be stopped suddenly. The dose must be lowered over a few days to prevent tremors, confusion, agitation, or a rapid increase in blood pressure.
Other drugs being studied to help people quit tobacco
A plant-based drug called cytisine has shown promise in other countries and is now being studied in the United States.
Naltrexone is a drug used to help those with alcohol and opioid abuse disorders. Studies are looking at ways to combine it with varenicline to help people quit smoking, especially people who smoke and are also heavy drinkers.
Also being tested are possible anti-smoking vaccines that are given as injections.
So far these new options seem to be safe, but their effect on smoking cessation has been disappointing.
Bupropion | Zyban | Stop Smoking Medicine
If you want to stop smoking, taking bupropion (trade name Zyban®) roughly doubles your chance of success.
Most people who quit smoking have tried three or four times to do so before they succeed. This is because smoking, or more specifically nicotine in cigarette smoke, is highly addictive. You start to get withdrawal symptoms only a few hours after smoking a cigarette. Bupropion (Zyban®) can help by reducing these withdrawal symptoms.
To read more about how addictive smoking can be and to find out how addicted you are, see the separate leaflet called Quit Smoking (Smoking Cessation).
Bupropion (Zyban®) is a medicine that was first developed to treat depression. It was found that it helped smokers to stop smoking. It is not clear how it works.
It alters the level of some chemicals in the brain (neurotransmitters).
This seems to relieve the withdrawal symptoms that you experience when you stop smoking (such as craving, feeling anxious, restlessness, headaches, irritability, hunger, difficulty concentrating, or just feeling awful).
Taking bupropion does increase the chance of quitting smoking. Various studies have looked at this issue. The studies compared bupropion to a similar dummy (placebo) tablet in people who were keen to stop smoking.
The results from the studies showed that, on average, about 19 in 100 people who took bupropion stopped smoking successfully. This compared to about 10 in 100 who took the dummy tablet.
In other words, about twice the number of smokers who take bupropion stop smoking compared to those who don't take bupropion. About 1 in 5 smokers who want to stop will do it with the help of bupropion.
- You need a prescription to obtain bupropion — you cannot buy it at pharmacies.
- Start by taking one tablet (150 mg) each day for six days. Then increase to one tablet twice a day, at least eight hours apart. Do not take more than one tablet at any one time, and not more than two tablets in a day. (If you are elderly or if you have certain liver or kidney diseases, the dose may be different — your doctor will advise.)
- Set a target date to stop smoking one to two weeks after starting treatment. This allows bupropion to build up in your body before you stop completely.
- You should continue the tablets for a further seven weeks. (So, this is eight weeks in total, which is two packs of tablets.)
Bupropion does not 'make' you stop smoking. You still need determination to succeed and to break the smoking habit.
A combination of bupropion with counselling from a nurse, doctor, pharmacist or other health professional increases your chance of successfully stopping smoking.
Therefore, most doctors will only prescribe bupropion to people who really want to stop smoking as part of a 'stopping smoking' programme.
Most people take bupropion without any problem. Read the packet leaflet for a full list of possible side-effects and cautions. The most common are a dry mouth (which occurs in about 1 in 10 users) and some difficulty in sleeping (which occurs in about 1 in 3 users). Less common but more serious possible side-effects include the following:
If this occurs you should not drive and you should not operate machinery.
This occurs in about 1 in 1,000 people who take bupropion. Therefore, although this is uncommon, it can be serious, particularly if it occurs when you are operating machinery or driving.
The risk of a seizure is increased if you have a history of certain medical conditions, or if you take certain medicines (listed below).
Therefore, bupropion is not suitable for all people who wish to stop smoking (see below).
High blood pressure
Blood pressure sometimes goes up in people who take bupropion. You should have a baseline blood pressure reading done before you start treatment and it should be monitored from time to time.
Bupropion weight loss
Some people experience weight loss when taking bupropion. However, the effect on body weight is variable and your weight may stay the same or even increase when taking bupropion.
The main risk of overdose is a seizure. Death can occur but is rare.
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
- The name of the medicine which you think caused it.
- The person who had the side-effect.
- Your contact details as the reporter of the side-effect.
It is helpful if you have your medication — and/or the leaflet that came with it — with you while you fill out the report.
You should not take bupropion if you:
- Are under the age of 18 years.
- Are pregnant or breastfeeding.
- Have ever had epilepsy, a seizure (fit or convulsion), or an unexplained blackout.
- Have ever had anorexia nervosa or bulimia nervosa.
- Have bipolar affective disorder (manic depression).
- Are withdrawing abruptly from benzodiazepines or alcohol dependence.
- Have a tumour of the brain or spinal cord.
- Have had a previous allergic reaction to bupropion tablets.
Also, the dose may need to be reduced if you have some medical conditions or if you take certain medicines. Tell your doctor or pharmacist if you:
- Have ever had a serious head injury.
- Have diabetes that is treated with insulin or medicines.
- Drink a lot of alcohol.
- Have a liver or kidney disease.
Bupropion combined with certain other medicines can increase the risk of having a seizure. Therefore, whilst you are taking bupropion, tell your doctor or pharmacist if you are prescribed or buy any new medicine. Also, tell a doctor or pharmacist if you are taking any of the following medicines:
- Antimalarial medicines (for example, chloroquine, proguanil).
- Medicines to treat depression or other mental illness.
- Theophylline, which is a medicine used to treat chest conditions.
- Steroids — taken as tablets or injections.
- Tramadol, which is a strong painkiller.
- Slimming medicines or other stimulant medicines.
If you are unable to take bupropion, there are other ways that you can get help to quit. See the separate leaflet called Quit Smoking (Smoking Cessation).
- Reid RD, Pritchard G, Walker K, et al; Managing smoking cessation. CMAJ. 2016 Dec 6188(17-18):E484-E492. doi: 10.1503/cmaj.151510. Epub 2016 Oct 3.
- Smoking cessation; NICE CKS, October 2012 (UK access only)
- British National Formulary (BNF); NICE Evidence Services (UK access only)
- Smoking: harm reduction; NICE Public Health Guidance, June 2013
- Wu J, Sin DD; Improved patient outcome with smoking cessation: when is it too late? Int J Chron Obstruct Pulmon Dis. 20116:259-67. doi: 10.2147/COPD.S10771. Epub 2011 May 2.
Stop smoking treatments
If you want to stop smoking, several different treatments are available from shops, pharmacies and on prescription to help you beat your addiction and reduce withdrawal symptoms.
The best treatment for you will depend on your personal preference, your age, whether you're pregnant or breastfeeding and any medical conditions you have. Speak to your GP or an NHS stop smoking adviser for advice.
Research has shown that all these methods can be effective. Importantly, evidence shows that they are most effective if used alongside support from an NHS stop smoking service.
The main reason that people smoke is because they are addicted to nicotine.
NRT is a medication that provides you with a low level of nicotine, without the tar, carbon monoxide and other poisonous chemicals present in tobacco smoke.
It can help reduce unpleasant withdrawal effects, such as bad moods and cravings, which may occur when you stop smoking.
Where to get it and how to use it
NRT can be bought from pharmacies and some shops. It's also available on prescription from a doctor or NHS stop smoking service.
It's available as:
- skin patches
- chewing gum
- inhalators (which look plastic cigarettes)
- tablets, oral strips and lozenges
- nasal and mouth spray
Patches release nicotine slowly. Some are worn all the time and some should be taken off at night. Inhalators, gum and sprays act more quickly and may be better for helping with cravings.
There's no evidence that any single type of NRT is more effective than another. But there is good evidence to show that using a combination of NRT is more effective than using a single product.
Often the best way to use NRT is to combine a patch with a faster acting form such as gum, inhalator or nasal spray.
Treatment with NRT usually lasts 8-12 weeks, before you gradually reduce the dose and eventually stop.
Who can use it
Most people are able to use NRT, including:
- adults and children over 12 years of age – although children under 18 should not use the lozenges without getting medical advice first
- pregnant women – your doctor may suggest NRT if they think it would help you quit; read more about stopping smoking in pregnancy
- breastfeeding women – your doctor can advise you how to do this safely
Always read the packet or leaflet before using NRT to check whether it's suitable for you.
Sometimes it may be advisable to get medical advice first, for example if you have kidney or liver problems, or you've recently had a heart attack or stroke.
Possible side effects
Side effects of NRT can include:
- skin irritation when using patches
- irritation of nose, throat or eyes when using a nasal spray
- difficulty sleeping (insomnia), sometimes with vivid dreams
- an upset stomach
Any side effects are usually mild. But if they're particularly troublesome, contact your GP as the dose or type of NRT may need to be changed.
Varenicline (brand name Champix) is a medicine that works in 2 ways. It reduces cravings for nicotine NRT, but it also blocks the rewarding and reinforcing effects of smoking.
Evidence suggests it's the most effective medicine for helping people stop smoking.
Possible side effects
Side effects of bupropion can include:
- dry mouth
- difficulty sleeping (insomnia)
- feeling and being sick
- difficulty concentrating
Speak to your GP if you experience any troublesome side effects.
An e-cigarette is an electronic device that delivers nicotine in a vapour. This allows you to inhale nicotine without most of the harmful effects of smoking, as the vapour contains no tar or carbon monoxide.
Research has found that e-cigarettes can help you give up smoking, so you may want to try them rather than the medications listed above. As with other approaches, they're most effective if used with support from an NHS stop smoking service.
There are no e-cigarettes currently available on prescription.
For now, if you want to use an e-cigarette to help you quit, you'll have to buy one. Costs of e-cigarettes can vary, but generally they're much cheaper than cigarettes.
Read more about e-cigarettes.
Page last reviewed: 17 July 2019
Next review due: 17 July 2022