David Baxter PhD
Late Founder
Quit-smoking products: Boost your chance of quitting for good
Mayo Clinic
Aug. 8, 2009
Want to quit smoking? Several quit-smoking products are available that can help you quit smoking for good. Some of these products are known as nicotine replacement therapy because they contain small amounts of nicotine. Others are prescription medications without nicotine. Either type of quit-smoking product can help reduce nicotine cravings and withdrawal symptoms, making it more likely you'll stop smoking for good.
Although you can buy some quit-smoking products without a prescription, it's best to consult your doctor before use. Together with your doctor, you can explore which quit-smoking products or combinations of products may be right for you, when to start taking them, and possible risks and side effects.
Nicotine patch
The nicotine patch is a small, self-adhesive patch that releases a slow, steady amount of nicotine into your body through your skin. You apply a new nicotine patch every day on a hairless area of skin between your waist and neck, such as your upper arm or chest.
Pros
The nicotine patch is available without a prescription in various doses. The patch is easy to use. The nicotine patch is long-acting, controlling nicotine cravings and withdrawal symptoms for 24 hours at a time. You can gradually taper off the nicotine patch as your cravings and withdrawal symptoms decrease.
Cons
You can't quickly adjust the amount of nicotine if you have sudden cravings or withdrawal symptoms. The patch may cause skin itching, rash and irritation where it's applied. Patches also may cause sleep disturbances and vivid dreams. Removing the patch at night may help. Patches must be replaced every 24 hours. To minimize potential skin irritation, avoid putting the patch in the same place more than once every two weeks or so.
Cautions
The patch may not be appropriate if you have certain skin conditions, such as eczema or psoriasis.
Timeline
You typically use the nicotine patch for eight to 12 weeks. You may need to use it longer if cravings or withdrawal symptoms continue.
Nicotine gum
Nicotine gum contains a small amount of nicotine. The nicotine enters your body as it's absorbed through the lining of your mouth when you use the gum according to directions.
Pros
Nicotine gum is available without a prescription in two doses. It's short-acting, which means it can control sudden nicotine cravings and withdrawal symptoms for short periods of time. When you first start using nicotine gum, you can use a piece every one to two hours, up to 24 pieces a day. Nicotine gum comes in several flavors.
Cons
You must use nicotine gum repeatedly throughout the day to control cravings or withdrawal symptoms. Nicotine gum may only take the edge off cravings, not make them go away completely. You must follow a specific biting technique for nicotine gum to work effectively. Don't chew it like chewing gum. To release nicotine from the gum, bite a piece until it has a peppery taste or you notice a tingly sensation in your mouth. Then, to let the nicotine absorb, hold the gum between your gumline and cheek until the taste or tingly sensation stops. To release more nicotine, bite and hold again. Repeat the cycle for about 30 minutes, then discard the gum because all the nicotine in it has been used. Side effects include jaw soreness from too much biting, as well as mouth irritation, nausea, stomach upset and excess saliva.
Cautions
Nicotine gum may stick to dentures or other dental work. Avoid eating or drinking anything but water for 15 minutes before use or during use to prevent nicotine absorption problems.
Timeline
Nicotine gum is recommended for up to 12 weeks. You can start by using a piece every hour or two, and then gradually reduce the frequency as cravings and withdrawal symptoms decrease.
Nicotine lozenge
Nicotine lozenges are tablets similar to hard candy and contain a small amount of nicotine. The nicotine enters your bloodstream as it's absorbed through the lining of your mouth. You place a lozenge between your gumline and cheek and suck it slowly, allowing it to dissolve.
Pros
Nicotine lozenges are available without a prescription in different doses. Lozenges are short-acting, which means they can control sudden nicotine cravings and withdrawal symptoms for short periods of time. You can use up to 20 lozenges a day. Lozenges come in several flavors.
Cons
You must use nicotine lozenges repeatedly throughout the day to control cravings or withdrawal symptoms. Nicotine lozenges may sometimes cause nausea, indigestion, heartburn, throat irritation or hiccups.
Cautions
Nicotine lozenges may stick to dentures or other dental work. They're not meant to be chewed or swallowed whole. Avoid eating or drinking anything but water for 15 minutes before use or during use to prevent nicotine absorption problems.
Timeline
Nicotine lozenges are recommended for about 12 weeks. Reduce how often you use the lozenges as your cravings and withdrawal symptoms decrease.
Nicotine inhaler
The nicotine inhaler is a device that gives you a small dose of nicotine. When you puff on the nicotine inhaler, nicotine vapor is released from a cartridge inside the device. The nicotine enters your bloodstream as it's absorbed through the lining of your mouth and throat. Hold the vapor in your mouth for a few seconds and then blow it out ? don't inhale it into your lungs.
Pros
The nicotine inhaler is short-acting, which means it can control sudden nicotine cravings and withdrawal symptoms for short periods of time. You control the dose of nicotine you receive. You can take as few puffs as needed to satisfy withdrawal symptoms or cravings and save the rest of the cartridge for later. The inhaler also keeps your hands busy, which can help with cigarette cravings.
Cons
The inhaler is available only by prescription. You must use the nicotine inhaler repeatedly throughout the day to control cravings or withdrawal symptoms. The nicotine inhaler may cause coughing and mouth or throat irritation.
Cautions
Check with your doctor before using the nicotine inhaler if you have any lung disease, such as asthma. Avoid eating or drinking anything but water for 15 minutes before use or during use to prevent nicotine absorption problems.
Timeline
Recommended use is six to 16 cartridges a day for six to 12 weeks, gradually tapering to none over the next six to 12 weeks.
Nicotine nasal spray
The nicotine nasal spray delivers a solution into your nostrils that contains a small dose of nicotine. The nicotine enters your body by being absorbed through the lining of your nose. The recommended dose is a spray in each nostril one to three times an hour.
Pros
The nicotine nasal spray is short-acting, which means it can control sudden nicotine cravings and withdrawal symptoms for short periods of time. The nasal spray also works faster than does nicotine gum, lozenges and the inhaler. You control the dose by using the spray as needed throughout the day.
Cons
Nicotine nasal spray is available only by prescription. It may be inconvenient, since you must use the nasal spray repeatedly throughout the day to control cravings or withdrawal symptoms. Side effects include nasal, sinus and throat irritation, watery eyes, sneezing and coughing. These effects typically go away with regular use over five to seven days. The nasal spray also poses a slight risk of dependency.
Cautions
Nicotine nasal spray isn't recommended if you have a nasal or sinus condition.
Timeline
Nicotine nasal spray is often used for about three to six months. Recommended use is one to three sprays an hour at first, gradually tapering to none.
Bupropion SR (Zyban)
Bupropion is a prescription medication classified as a type of antidepressant. A sustained-release (SR) form of bupropion is approved for smoking cessation. Unlike nicotine replacement therapy, bupropion SR doesn't contain nicotine. It's thought to decrease tobacco cravings and withdrawal symptoms by increasing the levels of certain brain chemicals.
Pros
Bupropion SR is a pill, so it's relatively easy to use. It isn't considered addictive.
Cons
Bupropion SR is available only by prescription, including the brand name Zyban. Because it takes five to seven days to be effective, you typically must start taking bupropion SR a week or two before you quit smoking. Side effects may include insomnia, agitation, headache and dry mouth. Rarely, a severe allergic reaction or seizure can occur. Also, you must remember to take the pill every day.
Cautions
In July 2009, the Food and Drug Administration (FDA) required bupropion SR to carry a black box warning ? the strongest safety warning that the FDA can issue about a prescription medication. The warning is required because bupropion SR may be associated with serious mental health problems either while taking it or after stopping it, including an increased risk of suicidal thoughts or behavior, hostility and depression. If you take bupropion SR, report any changes in mood or behavior to your doctor immediately and stop taking the medication. Bupropion SR isn't appropriate if you have a seizure or eating disorder, if you've lost consciousness for more than an hour because of head trauma, if you're already taking a medication containing bupropion, or if you take a type of antidepressant known as a monoamine oxidase inhibitor (MAOI).
Timeline
Bupropion SR is generally used for 12 weeks, but if you've successfully quit smoking, you can use it another six months to reduce the risk of a smoking relapse.
Varenicline (Chantix)
Varenicline is a prescription medication that can help reduce cravings for tobacco and control nicotine withdrawal symptoms. It also blocks nicotine receptors in your brain, which decreases the pleasurable effects of smoking.
Pros
Varenicline is a pill, so it's relatively easy to use. It isn't considered addictive.
Cons
Varenicline is available only by prescription, including the brand name Chantix. Some studies also have shown an increase in road accidents and falls among people taking varenicline. Other problems can include vision trouble, fainting, severe skin reactions, vivid or strange dreams, and impairment of the ability to drive or operate heavy machinery. Also, you must remember to take the pill every day.
Cautions
In July 2009, the FDA required varenicline to carry a black box warning ? the strongest safety warning that the FDA can issue about a prescription medication. The warning is required because varenicline may be associated with serious mental health problems either while taking it or after stopping it, including an increased risk of suicidal thoughts or behavior, hostility and depression. If you take varenicline, report any changes in mood or behavior to your doctor immediately and stop taking the medication. Varenicline should be used with caution if you have severe kidney problems.
Timeline
Varenicline is typically used for 12 weeks, but if you've successfully quit smoking, you can use it another 12 weeks to reduce the risk of a smoking relapse.
Need more help to quit smoking?
The most effective strategy to quit smoking for good is to combine a quit-smoking product with a program that includes support from professionals trained to treat tobacco dependence. Consider joining a community stop-smoking group or starting in-person or telephone counseling. Call 800-QUIT-NOW (800-784-8669) to obtain free telephone counseling services and information about stop-smoking programs near you.
References
Mayo Clinic
Aug. 8, 2009
Want to quit smoking? Several quit-smoking products are available that can help you quit smoking for good. Some of these products are known as nicotine replacement therapy because they contain small amounts of nicotine. Others are prescription medications without nicotine. Either type of quit-smoking product can help reduce nicotine cravings and withdrawal symptoms, making it more likely you'll stop smoking for good.
Although you can buy some quit-smoking products without a prescription, it's best to consult your doctor before use. Together with your doctor, you can explore which quit-smoking products or combinations of products may be right for you, when to start taking them, and possible risks and side effects.
Nicotine patch
The nicotine patch is a small, self-adhesive patch that releases a slow, steady amount of nicotine into your body through your skin. You apply a new nicotine patch every day on a hairless area of skin between your waist and neck, such as your upper arm or chest.
Pros
The nicotine patch is available without a prescription in various doses. The patch is easy to use. The nicotine patch is long-acting, controlling nicotine cravings and withdrawal symptoms for 24 hours at a time. You can gradually taper off the nicotine patch as your cravings and withdrawal symptoms decrease.
Cons
You can't quickly adjust the amount of nicotine if you have sudden cravings or withdrawal symptoms. The patch may cause skin itching, rash and irritation where it's applied. Patches also may cause sleep disturbances and vivid dreams. Removing the patch at night may help. Patches must be replaced every 24 hours. To minimize potential skin irritation, avoid putting the patch in the same place more than once every two weeks or so.
Cautions
The patch may not be appropriate if you have certain skin conditions, such as eczema or psoriasis.
Timeline
You typically use the nicotine patch for eight to 12 weeks. You may need to use it longer if cravings or withdrawal symptoms continue.
Nicotine gum
Nicotine gum contains a small amount of nicotine. The nicotine enters your body as it's absorbed through the lining of your mouth when you use the gum according to directions.
Pros
Nicotine gum is available without a prescription in two doses. It's short-acting, which means it can control sudden nicotine cravings and withdrawal symptoms for short periods of time. When you first start using nicotine gum, you can use a piece every one to two hours, up to 24 pieces a day. Nicotine gum comes in several flavors.
Cons
You must use nicotine gum repeatedly throughout the day to control cravings or withdrawal symptoms. Nicotine gum may only take the edge off cravings, not make them go away completely. You must follow a specific biting technique for nicotine gum to work effectively. Don't chew it like chewing gum. To release nicotine from the gum, bite a piece until it has a peppery taste or you notice a tingly sensation in your mouth. Then, to let the nicotine absorb, hold the gum between your gumline and cheek until the taste or tingly sensation stops. To release more nicotine, bite and hold again. Repeat the cycle for about 30 minutes, then discard the gum because all the nicotine in it has been used. Side effects include jaw soreness from too much biting, as well as mouth irritation, nausea, stomach upset and excess saliva.
Cautions
Nicotine gum may stick to dentures or other dental work. Avoid eating or drinking anything but water for 15 minutes before use or during use to prevent nicotine absorption problems.
Timeline
Nicotine gum is recommended for up to 12 weeks. You can start by using a piece every hour or two, and then gradually reduce the frequency as cravings and withdrawal symptoms decrease.
Nicotine lozenge
Nicotine lozenges are tablets similar to hard candy and contain a small amount of nicotine. The nicotine enters your bloodstream as it's absorbed through the lining of your mouth. You place a lozenge between your gumline and cheek and suck it slowly, allowing it to dissolve.
Pros
Nicotine lozenges are available without a prescription in different doses. Lozenges are short-acting, which means they can control sudden nicotine cravings and withdrawal symptoms for short periods of time. You can use up to 20 lozenges a day. Lozenges come in several flavors.
Cons
You must use nicotine lozenges repeatedly throughout the day to control cravings or withdrawal symptoms. Nicotine lozenges may sometimes cause nausea, indigestion, heartburn, throat irritation or hiccups.
Cautions
Nicotine lozenges may stick to dentures or other dental work. They're not meant to be chewed or swallowed whole. Avoid eating or drinking anything but water for 15 minutes before use or during use to prevent nicotine absorption problems.
Timeline
Nicotine lozenges are recommended for about 12 weeks. Reduce how often you use the lozenges as your cravings and withdrawal symptoms decrease.
Nicotine inhaler
The nicotine inhaler is a device that gives you a small dose of nicotine. When you puff on the nicotine inhaler, nicotine vapor is released from a cartridge inside the device. The nicotine enters your bloodstream as it's absorbed through the lining of your mouth and throat. Hold the vapor in your mouth for a few seconds and then blow it out ? don't inhale it into your lungs.
Pros
The nicotine inhaler is short-acting, which means it can control sudden nicotine cravings and withdrawal symptoms for short periods of time. You control the dose of nicotine you receive. You can take as few puffs as needed to satisfy withdrawal symptoms or cravings and save the rest of the cartridge for later. The inhaler also keeps your hands busy, which can help with cigarette cravings.
Cons
The inhaler is available only by prescription. You must use the nicotine inhaler repeatedly throughout the day to control cravings or withdrawal symptoms. The nicotine inhaler may cause coughing and mouth or throat irritation.
Cautions
Check with your doctor before using the nicotine inhaler if you have any lung disease, such as asthma. Avoid eating or drinking anything but water for 15 minutes before use or during use to prevent nicotine absorption problems.
Timeline
Recommended use is six to 16 cartridges a day for six to 12 weeks, gradually tapering to none over the next six to 12 weeks.
Nicotine nasal spray
The nicotine nasal spray delivers a solution into your nostrils that contains a small dose of nicotine. The nicotine enters your body by being absorbed through the lining of your nose. The recommended dose is a spray in each nostril one to three times an hour.
Pros
The nicotine nasal spray is short-acting, which means it can control sudden nicotine cravings and withdrawal symptoms for short periods of time. The nasal spray also works faster than does nicotine gum, lozenges and the inhaler. You control the dose by using the spray as needed throughout the day.
Cons
Nicotine nasal spray is available only by prescription. It may be inconvenient, since you must use the nasal spray repeatedly throughout the day to control cravings or withdrawal symptoms. Side effects include nasal, sinus and throat irritation, watery eyes, sneezing and coughing. These effects typically go away with regular use over five to seven days. The nasal spray also poses a slight risk of dependency.
Cautions
Nicotine nasal spray isn't recommended if you have a nasal or sinus condition.
Timeline
Nicotine nasal spray is often used for about three to six months. Recommended use is one to three sprays an hour at first, gradually tapering to none.
Bupropion SR (Zyban)
Bupropion is a prescription medication classified as a type of antidepressant. A sustained-release (SR) form of bupropion is approved for smoking cessation. Unlike nicotine replacement therapy, bupropion SR doesn't contain nicotine. It's thought to decrease tobacco cravings and withdrawal symptoms by increasing the levels of certain brain chemicals.
Pros
Bupropion SR is a pill, so it's relatively easy to use. It isn't considered addictive.
Cons
Bupropion SR is available only by prescription, including the brand name Zyban. Because it takes five to seven days to be effective, you typically must start taking bupropion SR a week or two before you quit smoking. Side effects may include insomnia, agitation, headache and dry mouth. Rarely, a severe allergic reaction or seizure can occur. Also, you must remember to take the pill every day.
Cautions
In July 2009, the Food and Drug Administration (FDA) required bupropion SR to carry a black box warning ? the strongest safety warning that the FDA can issue about a prescription medication. The warning is required because bupropion SR may be associated with serious mental health problems either while taking it or after stopping it, including an increased risk of suicidal thoughts or behavior, hostility and depression. If you take bupropion SR, report any changes in mood or behavior to your doctor immediately and stop taking the medication. Bupropion SR isn't appropriate if you have a seizure or eating disorder, if you've lost consciousness for more than an hour because of head trauma, if you're already taking a medication containing bupropion, or if you take a type of antidepressant known as a monoamine oxidase inhibitor (MAOI).
Timeline
Bupropion SR is generally used for 12 weeks, but if you've successfully quit smoking, you can use it another six months to reduce the risk of a smoking relapse.
Varenicline (Chantix)
Varenicline is a prescription medication that can help reduce cravings for tobacco and control nicotine withdrawal symptoms. It also blocks nicotine receptors in your brain, which decreases the pleasurable effects of smoking.
Pros
Varenicline is a pill, so it's relatively easy to use. It isn't considered addictive.
Cons
Varenicline is available only by prescription, including the brand name Chantix. Some studies also have shown an increase in road accidents and falls among people taking varenicline. Other problems can include vision trouble, fainting, severe skin reactions, vivid or strange dreams, and impairment of the ability to drive or operate heavy machinery. Also, you must remember to take the pill every day.
Cautions
In July 2009, the FDA required varenicline to carry a black box warning ? the strongest safety warning that the FDA can issue about a prescription medication. The warning is required because varenicline may be associated with serious mental health problems either while taking it or after stopping it, including an increased risk of suicidal thoughts or behavior, hostility and depression. If you take varenicline, report any changes in mood or behavior to your doctor immediately and stop taking the medication. Varenicline should be used with caution if you have severe kidney problems.
Timeline
Varenicline is typically used for 12 weeks, but if you've successfully quit smoking, you can use it another 12 weeks to reduce the risk of a smoking relapse.
Need more help to quit smoking?
The most effective strategy to quit smoking for good is to combine a quit-smoking product with a program that includes support from professionals trained to treat tobacco dependence. Consider joining a community stop-smoking group or starting in-person or telephone counseling. Call 800-QUIT-NOW (800-784-8669) to obtain free telephone counseling services and information about stop-smoking programs near you.
References
- Treating tobacco use and dependence: 2008 update. Rockville, Md.: U.S. Department of Health and Human Services. Treating tobacco use and dependence: 2008 update. Accessed May 15, 2009.
- Stead LF, et al. Nicotine replacement therapy for smoking cessation (review). Cochrane Database of Systematic Reviews. 2009:CD000146.
- Nicotine patch fact sheet. Smokefree.gov. http://www.smokefree.gov/quit-smoking/medicationguide/nicotine_patch.html Accessed May 13, 2009.
- Rennard SI, et al. Management of smoking cessation. UpToDate Inc. Accessed May 13, 2009.
- Public health alert: Important information on Chantix (varenicline). U.S. Food and Drug Administration. Accessed May 16, 2008.
- Ossip DJ, et al. Adverse effects with use nicotine replacement therapy among quitline clients. Nicotine & Tobacco Research. 2009;11:408.
- Nicotine gum fact sheet. Smokefree.gov. http://www.smokefree.gov/quit-smoking/medicationguide/nicotine_gum.html Accessed May 13, 2009.
- Nicotine lozenges fact sheet. Smokefree.gov. http://www.smokefree.gov/quit-smoking/medicationguide/nicotine_lozenges.html Accessed May 13, 2009.
- Nicotine inhaler fact sheet. Smokefree.gov. http://www.smokefree.gov/quit-smoking/medicationguide/nicotine_inhaler.html Accessed May 13, 2009.
- Nicotine nasal spray fact sheet. Smokefree.gov. http://www.smokefree.gov/quit-smoking/medicationguide/nicotine_spray.html Accessed May 13, 2009.
- Varenicline fact sheet. Smokefree.gov. http://www.smokefree.gov/quit-smoking/medicationguide/varenicline.html Accessed May 13, 2009.
- Bupropion fact sheet. Smokefree.gov. http://www.smokefree.gov/quit-smoking/medicationguide/bupropion.html Accessed May 13, 2009.
- Barbara Woodward Lips Patient Education Center. Medications to help you stop using tobacco. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2008.
- Hurt RD (expert opinion). Mayo Clinic, Rochester, Minn. May 26, 2009.
- FDA: Boxed warning on serious mental health events to be required for Chantix and Zyban. U.S. Food and Drug Administration. Accessed July 1, 2009.
