Smoking cessation - medications; Smokeless tobacco - medications; Medications for stopping tobacco

Non-habit forming prescription medication may help you quit nicotine and tobacco and keep you from starting again. These medications do not contain nicotine, and they work in a different way than nicotine replacement therapy.

Like other treatments, these medicines work best when they are part of a program that includes:

• Making a clear decision to quit and setting a quit date. See: Making the decision to quit tobacco
• Creating a plan to help when you next reach for a cigarette. See: Smoking tips on how to quit
• Getting support from a doctor, counselor, or support group. See: Stop smoking support programs

BUPROPION (Zyban®)

Bupropion is a pill that may help decrease your craving for tobacco when you are trying to quit.

Although bupropion is also prescribed for people with depression, it will help with quitting tobacco, whether or not you have problems with depression. The exact way bupropion helps with tobacco cravings is not clear.

Bupropion is not FDA-approved for people under age 18, and is generally not used for those who:

• Are pregnant
• Have a history of seizures, kidney failure, heavy alcohol use, eating disorders such as anorexia or bulimia, bipolar or manic depressive illness, or a serious head injury

How to take it:

• Bupropion works best if started 1 - 2 weeks before you stop smoking. Although most studies tested treatment durations of 7 - 14 weeks, you can take it for up to 6 months or a year.
• The most common dosage is 150 mg tablets once or twice per day.
• Taking bupropion along with nicotine patches, gums, or lozenges may work better for those who need help with the craving. Ask your doctor if this is okay for you.

Side effects that have been reported include:

• Dry mouth
• Problems sleeping. If this occurs, you can try taking the second dose of the day in the afternoon, but it must be at least 8 hours after the first dose.
• The FDA has required the makers of bupropion to add the strongest possible warning regarding serious mental health side effects that may occur while using the medication. These side effects include "changes in behavior, hostility, agitation, depressed mood, suicidal thoughts and behavior, and attempted suicide." Patients are advised to stop taking the medication right away if any of these symptoms occur.

VARENICLINE (CHANTIX®)

Varenicline (Chantix®) helps with the craving for nicotine and withdrawal symptoms. It affects the brain, decreasing the physical effects of nicotine. So even if you start smoking again after quitting, you will not get as much pleasure from it.

How to take it:

• Your doctor will ask you to start taking this medication a week before you quit cigarettes. You will take it for 12 - 24 weeks.
• You should take it after meals with a full glass of water.
• Your doctor will give you instructions. Usually, you will be asked to take one 0.5 mg pill a day at first. By the end of the second week, you will likely be taking a 1 mg pill twice a day.
• Based on current research, this drug should not be combined with nicotine replacement therapy.
• Varenicline is not FDA-approved, and therefore is not recommended for children under age 18.

Side effects are possible (although most of the time people tolerate varenicline well), including:

• Headaches, problems sleeping, sleepiness, and unusual dreams
• Constipation, intestinal gas, nausea, and changes in taste
• Depressed moods, as well as thoughts of suicide and attempted suicide have been reported. Call your doctor right away if you have any of these symptoms.

OTHER MEDICINES

There is some evidence that the following medicines may be helpful in quitting smoking when the first-line medicines have not worked. However, their benefits are less consistent, and they are considered "second-line."

• Clonidine (Catapres), normally used to treat high blood pressure, is also used to treat tobacco withdrawal symptoms
• Other antidepressants, such as fluoxetine (Prozac) and nortriptyline
• Buspirone (Buspar)

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Eisenberg MJ, Filion KB, Yavin D, et al. Pharmacotherapies for smoking cessation: a meta-analysis of randomized controled trials. CMAJ. 2008;179:135-144. Erratum in: CMAJ. 2008;179:802.

Fiore MC, Jaén CR, Baker TB, Bailey WC. Treating tobacco use and dependence: 2008 update--Clinical Practice Guideline. May 2008. Accessed December 25, 2009.

Guide to Quitting Smoking. American Cancer Society. Last Medical Review: 10/01/2009. Last Revised: 11/23/2009. Accessed December 14, 2009.