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Treatments and drugs

By Mayo Clinic staff

Like most smokers, you've probably made at least one recent, serious attempt to stop. You may be feeling discouraged about trying again. But it's rare to succeed on your first attempt to stop smoking — especially if you try to do it without help. You're much more likely to succeed if you use treatments that have been proved effective. Medications and counseling both work. Combining these approaches makes it even more likely to work.

Although it may be tough to break your tobacco dependence, the benefits are well worth the effort. Smoking is the single most preventable cause of death in the U.S.

Your health will benefit almost immediately if you stop smoking. Just 20 minutes after your last cigarette, your heart rate goes down. Twelve hours later, levels of carbon monoxide, a toxic gas, in your blood return to normal. Your lung function improves and your circulation starts to get better within three months. After a year, your risk of having a heart attack drops by half. And after five to 15 years, your stroke risk will be the same as that of a nonsmoker.

Medications
Many medications, including nicotine replacement therapy and non-nicotine medications, have been approved as safe and effective in treating tobacco dependence. Any of these medications, combined with behavioral changes, can increase your chances of quitting.

Using more than one medication may help you get better results than if you use a single medication. You'll get better results by combining a longer acting medication — such as the nicotine patch or the drug bupropion (Zyban, Wellbutrin) or varenicline (Chantix) — with a short-acting nicotine replacement product, such as nicotine gum, lozenge, nasal spray or inhaler.

If you've tried a medication on your own but haven't been able to stop smoking, talk to your health care provider. He or she can help you move in the right direction by adjusting the dose of your medication, recommending a different medication or using a combination of medications.

Most people who want to stop smoking can benefit from a medication. But if you're pregnant or breast-feeding, you smoke fewer than 10 cigarettes a day or you're under age 18, talk to your doctor before taking any over-the-counter nicotine replacement products.

Nicotine replacement therapy
Nicotine replacement therapy gives you nicotine without the other harmful chemicals in tobacco smoke. Many people mistakenly believe that nicotine causes cancer, but that's not the case. Nicotine replacement medications, including patches, gum, lozenges, nasal spray and inhaler, can help relieve difficult withdrawal symptoms and cravings. The best time to start using nicotine replacement is on the day you set to stop smoking.

Most nicotine replacement products are available over-the-counter:

• Nicotine patch (NicoDerm CQ, Habitrol, others). The patch delivers nicotine through your skin and into your bloodstream. You wear a new patch each day. The treatment period usually lasts for eight weeks or longer. Don't be in a hurry to stop using the patch, especially if you've stopped smoking or dramatically reduced your smoking. If you haven't been able to stop smoking completely after the two weeks or so of treatment, ask your doctor for help in adjusting the dose of the patch or adding another medication.
• Nicotine gum (Nicorette, others). This gum delivers nicotine to your blood through the lining of your mouth. It's available in a 2-milligram (mg) dose for regular smokers and a 4-mg dose for heavy smokers. You can use up to 20 pieces a day as needed. Nicotine gum is often recommended to curb cravings. To use the gum correctly, chew it a few times until you feel a mild tingling or peppery taste, then park the gum between your cheek and gumline for several minutes. This "chewing and parking" allows nicotine to be gradually absorbed in your bloodstream. Avoid drinking carbonated or acidic drinks, such as coffee or juice, before or while using nicotine gum or lozenges.
• Nicotine lozenge (Commit, Nicorette mini lozenge). This is a tablet that dissolves in your mouth and, like nicotine gum, delivers nicotine through the lining of your mouth. The lozenges are available in 2- and 4-mg doses, for regular or heavier smokers. To use the lozenge, place it in your mouth between your gumline and cheek or under your tongue and allow it to dissolve. You'll start with one lozenge every one to two hours and gradually increase the time between treatments.

These nicotine replacement products are available by prescription:

• Nicotine nasal spray (Nicotrol NS). The nicotine in this product, sprayed directly into each nostril, is absorbed through your nasal membranes into your blood vessels. The nasal spray delivers nicotine a bit quicker than gum, lozenges or the patch, but not as rapidly as smoking a cigarette. It's usually prescribed for three-month periods for up to six months. Side effects may include nasal irritation.
• Nicotine inhaler (Nicotrol). This device is shaped something like a cigarette holder. You puff on it, and it delivers nicotine vapor in your mouth. You absorb the nicotine through the lining in your mouth, where it then enters your bloodstream. Common side effects are mouth or throat irritation and occasional coughing.

Non-nicotine medications
Medications that don't contain nicotine include:

• Bupropion. The antidepressant drug bupropion (Zyban, Wellbutrin) increases levels of dopamine and norepinephrine, brain chemicals that are also boosted by nicotine. Bupropion may be prescribed along with a nicotine patch. Bupropion has the advantage of helping to minimize weight gain after you quit smoking. Side effects may include sleep disturbance and dry mouth. If you have a history of seizures or serious head trauma, such as a skull fracture, you shouldn't take this drug.
• Varenicline (Chantix). This medication acts on the brain's nicotine receptors, decreasing withdrawal symptoms and reducing the feelings of pleasure you get from smoking. Potential side effects include nausea, headache, insomnia and vivid dreams. Rarely, varenicline has been associated with serious psychiatric symptoms, such as depressed mood, agitation and suicidal thoughts.
• Nortriptyline (Pamelor). This tricyclic antidepressant has been shown to help smokers stop. It acts by increasing the levels of the brain neurotransmitter norepinephrine. It is used as a second line medication to treat tobacco dependence. Side effects may include dry mouth.
• Clonidine (Catapres). This drug is approved for use in treating high blood pressure, but may be used as a second line medication for tobacco dependence if other medications haven't helped. Its usefulness is limited because of side effects such as drowsiness and sedation.

Counseling, support groups and smoking cessation programs
Combining medications with behavioral counseling provides the best chance for long-term success in quitting tobacco use. Medications help you cope with withdrawal symptoms, while behavioral treatments help you develop the skills you need to stay away from tobacco over the long run. The more time you spend with a counselor, the better your treatment results will be.

Several types of counseling and support can help with stopping smoking:

• Telephone counseling. No matter where you live, you can take advantage of telephone counseling to help you give up tobacco. Every state in the U.S. has a telephone quit line, and some have more than one. To get help finding the one in your state that's the best fit for you, call 800-QUIT-NOW (800-784-8669).
• Individual or group counseling program. Your doctor may recommend local support groups or a treatment program where counseling is provided by a tobacco treatment specialist. Counseling helps you learn techniques for preparing to stop smoking and provides support for you during the process. Many hospitals, health care plans, health care providers and employers offer treatment programs or have tobacco treatment specialists who are certified to provide treatment for tobacco dependence. Nicotine Anonymous groups are available in many locations to provide support for smokers trying to quit.
• Internet-based programs. Several websites offer support and strategies for people who are trying to stop smoking. BecomeAnEX.org is free and provides information and techniques as well as blogs, community forums, ask the expert and many other features. Text messaging services, including personalized reminders about a quit-smoking plan, also may prove helpful.

Remember, it's common to lapse, and sometimes relapse. But your goal is no smoking at all — even light or occasional smoking is dangerous. You can learn from past experiences and what may have led to a lapse or relapse. Armed with that knowledge — you'll be stronger during your next attempt.

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