Optimizing Therapies

Health medicine serpent wings staff symbol

Medical therapies and treatment. Image by Pixabay.

Smoking cessation counseling and behavioral support, as well as medications, are effective and evidence-based tools for smoking cessation. The combination of medication and behavioral support is more effective than either intervention alone.1  To view, click on bullet entry below or scroll down.

 

Smoking Cessation Medications

FDA-approved medications for smoking cessation include nicotine replacement therapy, varenicline, and bupropion. Long-acting nicotine replacement therapy includes the nicotine patch. Short-acting forms of nicotine replacement therapy include the gum, lozenge, inhaler, and nasal spray.

SMOKING CESSATION MEDICATION OPTIONS
Medication How is it used? Usual dosing Possible side effects
Nicotine replacement therapy      
Nicotine patch

Worn on the skin, patches provide a steady dose of nicotine through the day.

These can be worn for 16 or 24 hours, and are changed daily.

For those who smoke more than 10 cigarettes (1/2 pack) a day: start with a 21mg patch, and will reduce the dose of the patch after several weeks.

For those who smoke 10 or fewer cigarettes a day: start with a 14mg patch, and will reduce the dose of the patch after several weeks.

Redness or irritation at the patch site.

Headache, dizziness, nausea, trouble sleeping.
Nicotine gum The gum is chewed and then kept between the cheek and the gum for 20-30 minutes.

For those who smoke their first cigarette within 30 minutes of waking: start with a 4mg gum every 1-2 hours. Space out the time between doses after several weeks.

For those who smoke their first cigarette after 30 minutes of waking: start with a 2mg gum every 1-2 hours. Space out the time between doses after several weeks.

Do not exceed 24 pieces of gum per day.

Mouth or throat irritation.

Nausea, heartburn, hiccups.
Nicotine lozenge The lozenge is allowed to dissolve slowly in the mouth.

For those who smoke their first cigarette within 30 minutes of waking: start with a 4mg lozenge every 1-2 hours. Space out the time between doses after several weeks.

For those who smoke their first cigarette after 30 minutes of waking: start with a 2mg lozenge every 1-2 hours. Space out the time between doses after several weeks.

Do not exceed 20 lozenges per day, or more than 5 lozenges in 6 hours.

Mouth or throat irritation.

Nausea, heartburn, hiccups.
Nicotine inhaler* Inhale or puff the vapor from the inhaler into the mouth and back of throat. Use 6 to 16 cartridges per day, gradually reducing the number after several weeks.

Mouth or throat irritation.

Cough.
Nicotine spray* Spray in each nostril.

1-2 sprays in each nostril per hour.

Maximum of 80 sprays per day.

 Nasal or throat irritation. Sneezing, watery eyes, coughing.
Prescription medication      

Varenicline*

(Chantix)

 A pill that is taken daily.

One 0.5mg tablet taken daily for 3 days, followed by one 0.5mg tablet twice a day for 4 days.

Maintenance dose of 1mg twice a day.

Nausea, constipation, gas.

Trouble sleep or unusual dreams.

Cardiovascular events.

Behavior changes, depression, agitation, or suicidal thoughts.

Bupropion*

(Zyban, Wellbutrin)

 A pill that is taken daily. One 150mg tablet daily for 3 days, followed by one 150mg tablet twice a day. 

Nausea, dry mouth, dizziness.

Trouble sleeping, anxiety, or suicidal thoughts.

Use is contraindicated in individuals with seizure disorders or history of eating disorder.

*Available by prescription only.

SMOKING CESSATION COUNSELING AND SUPPORT

Counseling and behavioral support can take the form of in-person counseling (e.g. by a physician or tobacco treatment counselor), telephone counseling (such as that available from state tobacco quitlines), or through various other modalities such as text messaging, online resources, or smartphone applications. Below are some examples of such resources.

TELEPHONE AND TEXTING RESOURCES
Connect with your state telephone quitline at 800-QUIT-NOW (800-784-8669). Telephone-based tobacco cessation treatment is available free of charge to residents of all U.S. states, the District of Columbia, U.S. Territories and Pacific Islands. Also available in Spanish. More information at Center for Disease Control and Prevention FAQs
Prefer texting? Sign up for SmokefreeTXT, a free text messaging program to provide help with smoking cessation. Sign up by visiting https://smokefree.gov/smokefreetxt or texting the word START to 47848. Also available in Spanish. More information at Smokefree text FAQs

Prefer to chat online? Try the National Cancer Institute's LiveHelp service to get live online assistance. Available in English and Spanish.
 
SMOKING CESSATION APPS
Click on device below selected app for link
QuitGuide
iPhone
Android
QuitSTART (made for teens who want to quit)
iPhone
Android
Additional resources:
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
American Cancer Society: Nicotine Replacement Therapy for Quitting Tobacco and Prescription Drugs to Help You Quit Tobacco
 
 
PROVIDER'S Tour
Step 3 Innovation
Next step 6 Follow-ups

 

 
  1.  Combined pharmacotherapy and behavioural interventions for smoking cessation. Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub3