What Are the Medicines for Nicotine Withdrawal?

There are two types of smoking cessation products: Some contain nicotine, and some don’t. Nicotine replacement therapy products, like gums, lozenges, sprays, and inhalers, work by giving you a small dose of nicotine without all the other dangerous chemicals found in cigarettes.

That way, you can wean yourself off the nicotine and withdrawal isn’t so bad. They don’t stop the cravings, though. Most nicotine replacement products are available over-the-counter.

There are also prescription drugs that don’t use nicotine. They change the way your brain works to ease withdrawal symptoms and make you not want to smoke as much or at all. The FDA has approved two of these products: bupropion (Zyban) and varenicline (Chantix).

Bupropion

Bupropion chloride was originally prescribed as an antidepressant. In 1997, the FDA approved it as the first medication to help people stop smoking, sold under the name Zyban.

It’s not clear exactly how bupropion works. Researchers do know that it blocks some of the chemicals in your brain that react with nicotine to make you feel good when you smoke. This will reduce cravings and ease other withdrawal symptoms.

Bupropion seems to especially reduce irritability and concentration problems. It could also help with the urge to overeat while you’re trying to quit.

Like all smoking cessation products, bupropion is recommended only for people who smoke 10 or more cigarettes a day, or about half a pack. Your doctor will probably have you start taking bupropion 1 to 2 weeks before you plan to quit, so it’ll be fully in your system when the time comes.

Most people take bupropion tablets for 12 weeks, and it’s safe to use as needed. 

Your doctor will start you on a 150 mg tablet in the morning, and may or may not increase this to twice a day. Evidence suggests that once-daily dosing is as effective as taking it twice, with fewer side effects.

Side effects include dry mouth and trouble sleeping, but these problems tend to go away after you take bupropion for about a week. You might also have anxiety, constipation, skin irritation, or dizziness.

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Varenicline

The FDA approved varenicline (Chantix) in 2006 to help people quit smoking. Studies show that taking it makes you two to three times more likely to quit for good.

Varenicline works on the same parts of the brain that nicotine does. So it gives you a good feeling without a cigarette’s harmful chemicals or the addiction. This makes it easier for you to handle withdrawal.

By blocking other chemicals in your brain, varenicline also makes smoking less enjoyable. As with bupropion, you’ll start taking it a week or two before you quit. Those last cigarettes won’t be as satisfying as they used to be, so quitting will be easier.

Varenicline tablets come in increasing doses, like bupropion. You’ll start off with 0.5 mg for a few days, then go up to 1 mg twice daily.

The major side effect of concern is an increase in depressed mood, suicidal thoughts, and behavioral changes. If you struggle with depression, or have an unstable psychiatric disorder, this is not the medication for you.  In addition, varenicline can cause vivid dreams, and nausea in some people.

WebMD Medical Reference Reviewed by Sabrina Felson, MD on March 22, 2017

Sources

SOURCES:

American Cancer Society: “Why is it so hard to quit smoking?”

Quit Smoking Community: “Chantix: Helpful or Dangerous?”;  “Medication to Quit Smoking: Does it Work?”; and “Zyban (Bupropion) for Smoking Cessation.”

Agency for Healthcare Research and Quality: “Clinical Guidelines for Prescribing Pharmacotherapy for Smoking Cessation.”

UpToDate.

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