Cessation Medications

Cessation medications are considered a crucial component of any attempt to quit cigarette smoking (in combination with counseling¹) but are underused by people making quit attempts (Figure 4.3.6). The first cessation medication to be approved by the FDA was nicotine replacement therapy (NRT). Nicotine is the ingredient in cigarettes largely responsible for dependence on cigarettes and withdrawal symptoms during quitting. Receiving nicotine from NRT, however, is much safer than nicotine smoked in cigarettes. Use of NRT in the initial phase of a quit attempt, and tapering the dose over time, decreases cravings and increases the user’s chances of abstinence by 50-60% compared to trying to quit without medication.² The various FDA-approved forms of NRT include lozenges, gum, patches, inhalers and nasal spray, and combinations of NRT can be used to manage acute and chronic cravings. NRT is available without a prescription and in various doses. Very dependent smokers may require higher doses initially or need to use it for a longer period to effectively manage their symptoms and/or remain smoke free.

For individuals who may not want to use NRT, two prescription medications have been approved by the FDA for cessation. Bupropion (marketed as Zyban™ or Wellbutrin™) is an anti-depressant that was discovered to be effective in reducing cravings during quitting; it was approved by the FDA for this purpose since 1985. Pharmacologically, it acts on neurotransmitters such as dopamine and norepinephrine, which are also involved in the subjective and physiological responses to smoking cigarettes. The sustained release (SR) form of bupropion is used for smoking cessation, but as with any prescription medication the appropriate dose and form, and possible side effects, should be discussed with a clinician. Another FDA-approved medication is varenicline (trade names Chantix™ or Champix™), which appears to be the most effective cessation medication to date.³ Medications that target other neurotransmitters or receptors are currently being evaluated for cessation.⁴

Combining medications that have different pharmacological profiles may be advantageous for some individuals attempting to quit.⁵ In addition, there is promising evidence that some of these medications may be effective in treating non-smoked forms of tobacco dependence (e.g., dependence on e-cigarettes).⁶