Quitting Smoking: Should I Use Medicine?

British Columbia Specific Information

The BC Smoking Cessation Program helps eligible B.C. residents stop smoking or using other tobacco products by assisting with the cost of smoking cessation prescription drugs or nicotine replacement therapy (NRT) products. For more information about the program, including how to get started, visit BC Smoking Cessation Program. For information about the health risks from smoking, tips on how to quit, an overview of smoking cessation aids, and more, see our Quit Smoking health feature. For more tools and resources to help you quit smoking and remain smoke-free, visit Quit Now.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Author	Healthwise Staff
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Brian D. O'Brien MD - Internal Medicine
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	Elizabeth T. Russo MD - Internal Medicine
Primary Medical Reviewer	John Hughes MD - Psychiatry

Quitting Smoking: Should I Use Medicine?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Use medicine to help you quit smoking. This may include nicotine replacement products.
Don't use medicine.

Key points to remember

Using medicines and nicotine replacement products (patches, gum, lozenges, and inhalers) can double your chances of quitting smoking.¹ They can relieve nicotine craving and withdrawal symptoms.
Getting counselling, along with using medicine, can increase your chances of quitting even more.
If you smoke fewer than 10 cigarettes a day, you may not need medicines to help you quit smoking.
It's rare for someone to get addicted to nicotine medicines, because the nicotine is released slowly at low levels into your bloodstream.
Nicotine replacement products may cause some side effects, such as problems with sleep or red and itchy skin with the patch. Medicines in pill form can cause nausea, dry mouth, and trouble sleeping. For most people, the side effects aren't bad enough to make them stop using the medicines.
Nicotine medicines have less than half of the nicotine than cigarettes. And by itself, nicotine is not nearly as harmful as smoking. The tars, carbon monoxide, and other toxic chemicals in tobacco cause the harmful effects.
Some provincial health plans and private health plans will pay for all or part of the cost of medicines used to quit smoking.

FAQs

What are the medicines?

Your doctor may prescribe varenicline (Champix) or bupropion (Zyban) to help you cope with cravings for tobacco. These medicines are pills that don't contain nicotine. You also can use nicotine replacement products, which do contain nicotine.

Medicines that don't have nicotine

Varenicline (Champix) blocks the effects of nicotine and reduces cravings and withdrawal symptoms. If you start smoking again while you are taking the medicine, you won't feel as satisfied. This improves your chances of quitting. You take it 2 times a day, after meals. You can also take varenicline for 12 more weeks than the other methods for a total of 24 weeks. There are three ways to quit smoking when you take varenicline. These methods are:
- Fixed: You will stop smoking after you have taken varenicline for one week.
- Flexible: You can pick a date to quit smoking between 8 and 35 days after you start taking varenicline.
- Gradual: You cut your smoking in half every 4 weeks until you quit at the end of 12 weeks, or sooner.
Bupropion SR (Zyban) can help balance chemicals in your brain to reduce your withdrawal symptoms. Doctors also prescribe this medicine (under the brand name Wellbutrin) to treat depression. But it can help you stop smoking even if you don't have depression. You start taking bupropion daily about 1 to 2 weeks before you quit smoking. You keep taking it for 7 to 12 weeks after you stop smoking.

Nicotine replacement products

Nicotine replacement gives your body some nicotine to help reduce withdrawal symptoms and cravings. Nicotine is addictive. But this treatment has about one-third to one-half the amount of nicotine in most cigarettes. It also delivers the nicotine slowly, so it rarely causes addiction. And these products don't have the harmful tars, carbon monoxide, and other toxic chemicals that are in tobacco.

There are several types of nicotine replacement:

Gum and lozenges slowly release nicotine into your mouth.
Patches stick to your skin and slowly release nicotine into your bloodstream.
An inhaler has a holder that contains nicotine. It delivers a puff of nicotine vapour into your mouth and throat.

You can buy nicotine gum, inhalers, patches, and lozenges without a prescription. You may be able to use a couple of these products at the same time, such as a patch and gum. But talk to your doctor first to make sure it's okay to mix nicotine medicines. People younger than age 18 can't buy the over-the-counter products, but a doctor may prescribe them.

Talk to your doctor if you're pregnant or planning to become pregnant and want to stop smoking.

If you have a health condition, such as mental illness or heart problems, or if you take medicine for a mental health problem, be sure to talk to your doctor before you use nicotine replacement products.

How well do medicines work?

Medicines can double your chances of quitting.¹

Some studies have found that varenicline (Champix) works better than bupropion SR (Zyban) and nicotine replacement.^2,³ But every person is different. So one medicine may work better for you than the other.
All forms of nicotine replacement products work about equally well when used in the right way.⁴
Your chances of quitting smoking are even better if you combine the patch with lozenges or gum.

What are the risks of using medicine to quit smoking?

Medicines that don't have nicotine

The most common side effects of varenicline (Champix) include:

Nausea.
Increased dreaming.
Trouble sleeping.

Some people also have side effects such as headaches and dizziness.

Champix may be linked with a small increase in risk for heart problems (including heart attack). Call your doctor if you have any cardiovascular disease symptoms that are new or getting worse, such as chest pain or pressure, shortness of breath, calf pain when walking, or sudden onset of weakness, numbness, or difficulty speaking.

Some people who take bupropion SR (Zyban) have:

Dry mouth.
Trouble sleeping.

There is a small risk of having seizures when you use bupropion. The risk increases if you have had a head injury or seizures.

Tell your doctor about all the medicines you take. When you stop smoking, there may be a change in how other medicines work for you.

Warnings. Health Canada warns that people who are taking bupropion (Zyban) or varenicline (Champix) and who experience any serious or unusual changes in mood or behaviour or who feel like hurting themselves or someone else should stop taking the medicine and call a doctor right away. If you already have a mood or behaviour problem, be sure to tell your doctor before you decide to use these medicines.

Nicotine replacement products

The side effects depend on the type of nicotine replacement product.

Nicotine patches can cause itching and redness where you put the patch. If you use a 24-hour patch, you may have trouble sleeping or have very vivid dreams. This is because your brain isn't used to getting nicotine when you're sleeping. Taking off the patch a few hours before you go to sleep usually helps ease your sleep problems.
Nicotine gum can cause an upset stomach (nausea) or heartburn. Gum is not a good choice for people who have dentures or problems with their jaw joint (TM disorders).
Nicotine lozenges can cause an upset stomach, hiccups, heartburn, and gas.
Nicotine inhalers can cause a cough, a scratchy throat, and an upset stomach. An inhaler may not be a good choice if you have asthma, allergies, or a sinus problem.

There is a small chance of addiction with the gum or lozenges.

Why might your doctor recommend that you use medicine?

Your doctor might recommend that you use medicine to stop smoking if:

You have tried on your own to stop smoking but you weren't able to stop.
You smoke more than 10 cigarettes a day.

2. Compare your options

	Use medicines to quit smoking	Don't use medicines
What is usually involved?	You take pills or use nicotine replacement products, such as patches, gum, lozenges, or inhalers, as your doctor recommends. Your doctor can prescribe pills. You can buy the other products without a prescription. You may also join a support group or have counselling to help you quit.	You could quit on your own by: Stopping all at once ("cold turkey"). Cutting down slowly on the number of cigarettes you smoke. You may join a support group or have counselling to help you quit.
What are the benefits?	You can double your chances of quitting smoking. The medicines can reduce your craving for tobacco and your nicotine withdrawal symptoms.	You don't have the cost of medicines. You don't have possible side effects.
What are the risks and side effects?	The medicine might not work to help you quit smoking. You could have side effects. These depend on the type of medicine. Side effects may include: Nausea. Vivid dreams. Dry mouth. Trouble sleeping. Itching and redness where the patch is placed. Heartburn. Headaches. Cough.	Quitting on your own might not work.

Personal stories

Personal stories from people who have quit smoking

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I started smoking when I was in the military. But it is affecting my health, and I want to quit. I've tried the patch, gum, and cold-turkey methods to quit, and they didn't work. So I talked with my doctor about quitting, and he suggested that I try using Champix. He also recommended that I have counselling and join a support group. It's been a little over a month since I started Champix, and so far it is helping with my craving to smoke. Talking in counselling is also helpful. I think I finally am going to be able to quit."

— Dave, age 42

"I thought about taking medicine to quit smoking, but I already take several other medicines for health problems. I just didn't want to take another prescription medicine and take the chance that it might cause problems. So I decided to try the nicotine patch. I set a date and started planning for the physical effects of quitting, like having munchies around and cleaning my car and house. I started with the largest patch available. It was great because the withdrawal symptoms were hardly noticeable. Then I went to the medium patch and finally the smallest patch. Now I don't smoke anymore."

— Alanna, age 44

"I started smoking at 15. I always thought I could quit at any time and had tried to quit dozens of times. But then I'd start craving a smoke, and I'd go back to cigarettes. A few years ago, my doctor suggested I try taking Zyban and nicotine gum. It was great, because between the pills and the gum, the withdrawal symptoms were hardly noticeable. I was done with the gum after the first few weeks, but I ended up staying on the pills for 6 months. But using both worked for me, and I haven't smoked for 2 years."

— Carlo, age 52

"My friends pushed me to quit smoking and suggested I talk to my doctor about getting some medicine to help. But I just wasn't comfortable with the idea of taking medicine. I have a strong will, and when I put my mind to doing something, I can usually do it. So I took my doctor's advice to have professional counselling to help improve my chances of success. I quit smoking—cold turkey—5 months ago. All my friends are really surprised that I could quit like that. It has been tough at times fighting the cravings, but it has worked."

— Kesia, age 35

"The first time I tried to quit, I went cold turkey. It only lasted a week. The next time I tried some kind of gum. This was in the '70s or '80s, so it was whatever kind of gum was available then, probably not the same as nicotine gum now. I quit smoking for a year that time, but I always craved cigarettes. The third time was right before I turned 60. I used Zyban and the nicotine patch for 6 weeks. I'm amazed at how well it worked. I have had no cravings for cigarettes, even from the very first day when I had my morning coffee. My father-in-law told me that, even 20 years after quitting, he still craved cigarettes every day, so that's what I was expecting. I didn't even throw away my cigarettes because I didn't expect it to work, but it worked incredibly well."

— Roy, age 63

"I started smoking at 13. I always thought I could quit at any time. But at 33 I was smoking a pack a day and had tried to quit dozens of times. I tried cold turkey. I was so grumpy I made a waiter cry. I tried hypnosis. It didn't work. I tried nicotine gum. It didn't work either. Finally, I tried the patch. I started with the largest one available. It was great because the withdrawal symptoms were hardly noticeable. Then I went to the medium patch and finally the smallest patch. I was really nervous about taking off that last patch. But I'd tapered off the nicotine so much that I had no withdrawal symptoms. That was nearly 12 years ago and I'm still smoke-free."

— Nancy, age 46

"Cigarettes were my best friend. They went on all my travelling adventures and they were there for me when I needed them, through heartbreaks, frustrations, and new jobs—20 years of companionship. I set a date and started planning. I bit the bullet and sent an e-mail out to all my friends and family, and I was floored by the support I got. A friend recommended acupuncture, so I made an appointment. For added incentive, I added daily exercise and a dog to my "new life." It has been 4 months and I am still a non-smoker. I had daily cravings for the first 2 weeks, but now I go entire days without even thinking about cigarettes. If I ever start feeling on the edge, I will head right back to the acupuncturist for a tune-up!"

— Leta, age 35

"I quit smoking cold turkey 3 months ago. All my friends are really surprised that I quit. I mean, I would wake up every 2 hours at night to smoke a cigarette. People just identified me with smoking. I finally decided it was time to quit when I couldn't catch my breath walking up stairs. Other than gaining a few kilograms, it really hasn't been bad."

— Ian, age 52

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to use medicine to quit smoking

Reasons not to use medicine

I want to use medicine if it can increase my chances of quitting.

I don't like using medicine.

More important

Equally important

More important

I'm not concerned about possible side effects.

I am very concerned about side effects.

More important

Equally important

More important

I'm not worried about how I will pay for the medicine.

I'm worried about how I will pay for the medicine.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Using medicine

NOT using medicine

Leaning toward

Undecided

Leaning toward

Credits

By	Healthwise Staff
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Brian D. O'Brien MD - Internal Medicine
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	Elizabeth T. Russo MD - Internal Medicine
Primary Medical Reviewer	John Hughes MD - Psychiatry

References

Citations

Stead LF, et al. (2012). Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews (11).
Varenicline (Chantix) for tobacco dependence (2006). Medical Letter on Drugs and Therapeutics, 48(1241/1242): 66–68.
Kralikova E, et al. (2013). Fifty-two-week continuous abstinence rates of smokers being treated with varenicline versus nicotine replacement therapy. Addiction, 108(9): 1497–1502.
Drugs for tobacco dependence (2008). Treatment Guidelines From The Medical Letter, 6(73): 61–66.

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