Medications are not the silver bullet, but they help!
It is important to remember that smoking addiction is a complex disorder involving biomedical, psychological, social, and even spiritual components. A pill, a patch, or a piece of gum is not going to miraculously fix an addiction, which in itself is complex enough.
Some people can quit by themselves, but most people successfully quit smoking when they use a combination of medications, counseling, and emotional support, which together address both the physical and psychological parts of smoking addiction.
Medications such as nicotine replacement (gum, lozenges, nasal spray, inhaler, patch), bupropion (Zyban®),* or varenicline (Chantix®) can help dramatically with cravings and withdrawal symptoms during the first weeks to months of smoking cessation.
Talk to your doctor about what approach or combination of approaches is right for you.
Nicotine replacement therapy (NRT)
Nicotine replacement therapy (NRT) helps reduce withdrawal symptoms so that people trying to quit smoking are able to focus on the psychological components of smoking addiction. NRT is most effective when combined with a smoking cessation program; people who use this combination can double their chance of quitting.
Talk to your doctor about whether nicotine replacement is right for you, what form of replacement they recommend (e.g., gum, lozenge, nasal spray, inhaler, patch), how long you should use it, what side effects to expect, and the maximum dose you can take each day.
Gum (Nicorette®, Thrive®, generics)
Nicotine gum provides fast-acting nicotine replacement that is flexible to an individual's needs. When a craving occurs, the person chews on the gum and absorbs nicotine directly through the tissues of the mouth. Chew the gum slowly for a few times until there is a peppery taste or a tingling feeling in your mouth, then "park" it (allow it to sit in your mouth between your gum and cheek) until the peppery taste or tingling feeling goes away. Then repeat the chewing and parking cycle for about 30 minutes. This is the amount of time it takes to release most of the nicotine from the gum.
Nicotine gum comes in 2 strengths - 2 mg and 4 mg. Someone who smokes a pack of cigarettes or more a day might prefer the higher dose, and after they are smoke-free for several weeks they can switch to a lower dose and gradually wean themselves from the gum.
To be absorbed properly, the nicotine from nicotine gum needs an alkaline environment. Therefore, people using nicotine gum should avoid coffee, juice, and other acidic foods while using the gum and wait 15 minutes before using the gum. Nicotine gum is usually used for 1 to 3 months, but some people may need it for up to 6 months. Some people who use nicotine gum may become dependent on the gum. Do not smoke while you are using the gum.
Side effects from the gum include nausea, mouth irritation, racing heartbeat, and indigestion. If you get nauseous or dizzy, stop chewing and make sure you are parking the gum so the nicotine can be absorbed - swallowing the nicotine can lead to nausea and dizziness. Some people complain about the taste of the gum.
Patch (Habitrol®, Nicoderm®, CQ, Nicotrol®, Prostep®)
The nicotine patch can be applied to clean, dry, non-hairy skin areas below the neck and above the waist. Several brands of patch are available, each offering a variety of doses. Some patches are taken off at night (16-hour dosing) and some are worn 24 hours a day. Most people start with the higher-dose patch for 4 weeks and then switch to a lower-dose patch for 4 weeks. Do not smoke while you are using the patch.
When combined with counseling, both the patch and the gum have been shown to result in twice the rates of successful quitting at 6 months when compared to the effect of counseling and taking a placebo (a patch or gum without the active ingredients).
Some people find the patch causes irritation or a rash at the site of application. Other side effects include nausea, headache, and trouble sleeping.
Nicotine nasal spray (Nicotrol® NS) and nicotine inhalers (Nicotrol® Inhaler)
Nicotine nasal sprays works very fast since the nicotine is absorbed quickly through the nose. The spray is usually used for 3 months and not longer than 6 months. Side effects can include nose irritation, sneezing, coughing, and a runny nose. Nicotine inhalers also offer fast relief from cravings and can be used for up to 6 months. Common side effects include nausea, coughing, and throat irritation. Do not smoke while you are using the inhaler.
Nicotine Lozenges (Commit®)
Nicotine from the lozenge is absorbed through the membranes in the mouth. It is available in strengths of 2 mg and 4 mg, and should be sucked (not chewed or swallowed) until dissolved. The lozenge is usually used for 3 months. Food and drinks can affect how the lozenge works and should be avoided for 15 minutes before using the lozenge. Common side effects that can occur include headaches, nausea, heartburn, and trouble sleeping. If you continue to use tobacco or other products containing nicotine, do not use the lozenges.
Non-nicotine medications
Bupropion (Zyban®)
This medication is an antidepressant that helps to reduce the symptoms of nicotine withdrawal. It works by altering the balance of chemicals in the brain that are involved in nicotine addiction.
People using bupropion start to get ready to quit and are prescribed the medication 1 to 2 weeks before the quit date. This allows the medication to begin to work before nicotine is withdrawn.
Side effects consisting of nausea, irritability, and headache are usually short-lived. Bupropion should not be taken by people with a history of a seizure disorder, head injury, heavy alcohol use, bipolar disorder, and eating disorders.
Varenicline (Chantix®)
Varenicline helps to reduce the symptoms of nicotine withdrawal and reduces the pleasurable effects of smoking by blocking nicotine receptors in the brain. Using varenicline along with counseling can double the chances of quitting successfully. Common side effects include headache, nausea, sleeping problems, and gas.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.