Tobacco use is the most common preventable cause of death. About half of the people who don't quit smoking will die of smoking-related problems. Quitting smoking is important for your health.

Soon after you quit, your circulation begins to improve, and your blood pressure starts to return to normal. Your sense of smell and taste return, and it's easier for you to breathe. In the long term, giving up tobacco can help you live longer. Your risk of getting cancer decreases with each year you stay smoke-free.

Quitting is not easy. You may have short-term affects such as weight gain, irritability, and anxiety. Some people try several times before they succeed. There are many ways to quit smoking. Some people stop "cold turkey." Others benefit from step-by-step manuals, counseling, or medicines or products that help reduce nicotine addiction. Some people think that switching to e-cigarettes can help you quit smoking, but that has not been proven. Your health care provider can help you find the best way for you to quit.

You may think that you can use tobacco without becoming addicted. But the truth is, most teens who use tobacco will get hooked. Three out of four teens who smoke cigarettes in high school will still be smoking as adults.

What Is Nicotine?Nicotine is the chemical found in tobacco products that is responsible for addiction. When you use tobacco, nicotine is quickly absorbed into your body and goes directly to your brain. Nicotine activates areas of the brain that make you feel satisfied and happy. Whether you smoke, vape, or dip, the nicotine you are putting in your body is dangerously addictive and can be harmful to your developing brain.

What Does Nicotine Addiction Look Like?

Nicotine addiction can look different from person to person. Even if you only use tobacco once in a while, you can be addicted and can have a hard time quitting.

Some signs of nicotine addiction include:

• Cravings, or feeling like you really need to use tobacco.
• Going out of your way to get tobacco.
• Feeling anxious or irritable if you want to use tobacco but can’t.
• Continuing to use tobacco because you find it hard to stop.

If you’re addicted to nicotine, you may experience symptoms of nicotine withdrawal after you stop using tobacco. Craving cigarettes, feeling sad or irritable, or having trouble sleeping are some common symptoms of withdrawal. These symptoms are usually strongest in the first week after quitting, but they are only temporary.

Why Is Nicotine Dangerous?

Nicotine can lead to addiction, which puts you at risk of becoming a lifelong smoker and exposing you to the many harmful chemicals in tobacco. These chemicals cause cancer and harm almost every organ in your body. Teens are especially sensitive to nicotine’s addictive effects because their brains are still developing. This makes it easier to get hooked. Using nicotine during your teen years can also rewire your brain to become more easily addicted to other drugs.

Nicotine can have other long-lasting effects on your brain development, making it harder for you to concentrate, learn, and control your impulses.

Smoking is the leading cause of premature, preventable death in this country. Cigarette smoking and exposure to tobacco smoke cause about 480,000 premature deaths each year in the United States. Of those premature deaths, about 36% are from cancer, 39% are from heart disease and stroke, and 24% are from lung disease. Mortality rates among smokers are about three times higher than among people who have never smoked.

Smoking harms nearly every bodily organ and organ system in the body and diminishes a person’s overall health. Smoking causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia.

Smoking also causes heart disease, stroke, aortic aneurysm (a balloon-like bulge in an artery in the chest), chronic obstructive pulmonary disease (COPD) (chronic bronchitis and emphysema), diabetes, osteoporosis, rheumatoid arthritis, age-related macular degeneration, and cataracts, and worsens asthma symptoms in adults. Smokers are at higher risk of developing pneumonia, tuberculosis, and other airway infections. In addition, smoking causes inflammation and impairs immune function.

Since the 1960s, a smoker’s risk of developing lung cancer or COPD has actually increased compared with nonsmokers, even though the number of cigarettes consumed per smoker has decreased. There have also been changes over time in the type of lung cancer smokers develop – a decline in squamous cell carcinomas but a dramatic increase in adenocarcinomas. Both of these shifts may be due to changes in cigarette design and composition, in how tobacco leaves are cured, and in how deeply smokers inhale cigarette smoke and the toxicants it contains.

Smoking makes it harder for a woman to get pregnant. A pregnant smoker is at higher risk of miscarriage, having an ectopic pregnancy, having her baby born too early and with an abnormally low birth weight, and having her baby born with a cleft lip and/or cleft palate. A woman who smokes during or after pregnancy increases her infant’s risk of death from Sudden Infant Death Syndrome (SIDS). Men who smoke are at greater risk of erectile dysfunction.

The longer a smoker’s duration of smoking, the greater their likelihood of experiencing harm from smoking, including earlier death. But regardless of their age, smokers can substantially reduce their risk of disease, including cancer, by quitting.

Secondhand smoke (also called environmental tobacco smoke, involuntary smoking, and passive smoking) is the combination of “sidestream” smoke (the smoke given off by a burning tobacco product) and “mainstream” smoke (the smoke exhaled by a smoker).

The U.S. Environmental Protection Agency, the U.S. National Toxicology Program, the U.S. Surgeon General, and the International Agency for Research on Cancer have classified secondhand smoke as a known human carcinogen (cancer-causing agent). Inhaling secondhand smoke causes lung cancer in nonsmoking adults. Approximately 7,300 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke. The U.S. Surgeon General estimates that living with a smoker increases a nonsmoker’s chances of developing lung cancer by 20 to 30%.

Secondhand smoke causes disease and premature death in nonsmoking adults and children. Exposure to secondhand smoke irritates the airways and has immediate harmful effects on a person’s heart and blood vessels. It increases the risk of heart disease by an estimated 25 to 30%. In the United States, exposure to secondhand smoke is estimated to cause about 34,000 deaths from heart disease each year. Exposure to secondhand smoke also increases the risk of stroke by 20 to 30%. Pregnant women exposed to secondhand smoke are at increased risk of having a baby with a small reduction in birth weight.

Children exposed to secondhand smoke are at an increased risk of SIDS, ear infections, colds, pneumonia, and bronchitis. Secondhand smoke exposure can also increase the frequency and severity of asthma symptoms among children who have asthma. Being exposed to secondhand smoke slows the growth of children’s lungs and can cause them to cough, wheeze, and feel breathless.

What are the immediate health benefits of quitting smoking?

The immediate health benefits of quitting smoking are substantial:

• Heart rate and blood pressure, which are abnormally high while smoking, begin to return to normal.
• Within a few hours, the level of carbon monoxide in the blood begins to decline. (Carbon monoxide reduces the blood’s ability to carry oxygen.)
• Within a few weeks, people who quit smoking have improved circulation, produce less phlegm, and don’t cough or wheeze as often.
• Within several months of quitting, people can expect substantial improvements in lung function.
• Within a few years of quitting, people will have lower risks of cancer, heart disease, and other chronic diseases than if they had continued to smoke.

What are the long-term health benefits of quitting smoking?

Quitting smoking reduces the risk of cancer and many other diseases, such as heart disease and COPD, caused by smoking.

Data from the U.S. National Health Interview Survey show that people who quit smoking, regardless of their age, are less likely to die from smoking-related illness than those who continue to smoke. Smokers who quit before age 40 reduce their chance of dying prematurely from smoking-related diseases by about 90%, and those who quit by age 45-54 reduce their chance of dying prematurely by about two-thirds.

Regardless of their age, people who quit smoking have substantial gains in life expectancy, compared with those who continue to smoke. Data from the U.S. National Health Interview Survey also show that those who quit between the ages of 25 and 34 years live about 10 years longer; those who quit between ages 35 and 44 live about 9 years longer; those who quit between ages 45 and 54 live about 6 years longer; and those who quit between ages 55 and 64 live about 4 years longer.

Also, a study that followed a large group of people age 70 and older found that even smokers who quit smoking in their 60s had a lower risk of mortality during follow-up than smokers who continued smoking.

Tobacco use is the leading preventable cause of death in the United States, resulting in more than 480,000 deaths annually. Almost 70 percent of current smokers report wanting to quit smoking, but quitting can be hard and often takes multiple attempts. A variety of FDA-approved medications are available to help people successfully quit smoking. During a January 26, 2018 FDA public hearing focused on FDA’s approach to evaluating nicotine replacement therapies, we heard concerns about misperceptions around smoking cessation medications and we want to help separate fact from fiction.

The best way to quit is “cold turkey.”

FICTION!

There is no “right way” to quit smoking, but many smokers try to quit “cold turkey” and are not successful. The good news is that there are several proven methods to help you quit smoking. There are many ways to get help and there are multiple options proven to be safe and effective when trying to quit. Over-the-counter nicotine replacement therapy products and prescription medications can help minimize the withdrawal symptoms and cravings when trying to quit. Studies show that using cessation medicines can double your chances of successfully quitting, and behavioral support (such as counseling) can also increase your likelihood of success. In fact, according to several studies done by the National Institutes of Health, medication plus behavioral support is more effective than either alone. Your doctor can help you determine what approach is best for you and you can learn about different tools available to help you quit smoking by visiting http://smokefree.gov.

All smoking cessation medications are the same.

FICTION!

There are 3 different types of medications approved by the FDA to help you quit smoking — nicotine replacement therapies, bupropion, and varenicline. Nicotine replacement therapy medications are available in five different forms: inhaler, nasal spray, patch, gum, or lozenge (see this FDA Consumer Update for more information). The medications vary in how they affect the body, how they are used, and how long they should be used. Some are available over-the-counter, and others require a prescription from your doctor. Talk to your doctor to determine which option might be best for you.

E-cigarettes are not an approved method to help people quit smoking.

FACT!

E-cigarettes are not approved by the FDA as an aid to quit smoking and may expose users to some of the same toxic chemicals found in combustible cigarette smoke. There are other proven, safe, and effective methods for quitting smoking. One way to start is to talk to your doctor to determine which option might be best for you. You can also visit http://smokefree.gov for more information, free tips and tools to help you quit smoking.

Nicotine is not the primary cause of cancer from most tobacco products.

FACT!

Nicotine is the main addictive substance in cigarettes and other tobacco products, including most e-cigarettes. Nicotine is a naturally occurring addictive chemical that is found in tobacco and is what keeps people smoking. However, while nicotine has a number of toxic effects on the body, it is not the primary cause of cancer and other chronic smoking-related diseases. More than 7,000 chemicals are present in cigarette smoke, including more than 70 that can cause cancer. Examples of cancer causing chemical found in cigarettes include tobacco-specific nitrosamines, benzo-a-pyrene, benzene, arsenic, and more (see "Chemicals in Cigarettes: from plant to product to puff").

It is dangerous to use more than one nicotine replacement therapy product at the same time.

FICTION!

Although each nicotine replacement therapy product was approved as an individual therapy (a standalone medication), two nicotine replacement therapy products can be used safely together when you are trying to quit (see Federal Register Notice Modifications To Labeling of Nicotine Replacement Therapy Products for Over-the-Counter Human Use). For example, some smokers combine products, using a nicotine replacement therapy patch for general relief of withdrawal symptoms, then a nicotine replacement therapy gum or inhaler for sudden urges to smoke. It may take multiple tries to find out what works best to help you quit.

Research shows that nicotine replacement therapy is safe and effective for almost all adults, but some people should not use nicotine replacement therapy. Pregnant women, teens, and people with serious health issues such as heart disease and stomach ulcers should talk to their doctor first before using nicotine replacement therapy. In addition, if considering combining nicotine replacement therapy products, talk to your doctor to help you decide if combination therapy is right for you.

Nicotine replacement therapy gum is different than regular gum.

FACT!

Unlike regular chewing gum, nicotine replacement therapy gum is most effective when used as directed — that is placed ( “parked”) between cheek and gum. You should start by placing the nicotine replacement therapy gum in your mouth and chewing until there is a strong taste or tingling sensation, which indicates that the nicotine is being released. Then, stop chewing and place it between your cheek and gum. When the taste or tingling sensation decreases, repeat the chew and park process. This process helps your body absorb the nicotine.

Nicotine replacement therapy can be used only for the duration listed on the label.

FICTION!

Although the duration listed on the label may work for some smokers, it might not work for others. Talk to your doctor if you feel extending your use would help you stay smoke-free.

If you've tried nicotine replacement therapy in the past and it didn't work, there is still reason to try it again.

FACT!

Research shows most smokers have to make multiple attempts to quit before being able to quit for good, even when using a proven cessation medication, like nicotine replacement therapy. The best thing to do is try again. FDA’s public education campaign, Every Try Counts, was designed with this important message in mind and encourages adult cigarette smokers to quit through messages of support that underscore the health benefits of quitting. The campaign aims to change attitudes and beliefs about what it means to quit smoking; increase motivation to try quitting again; and encourage smokers to practice the quit, because each attempt to quit makes quitting for good more likely.

By knowing the facts and using proven methods to quit smoking, you can improve your chances of success. But, if you don’t succeed on the first try, remember that every try counts.

This medication guide was created to provide you with a general understanding of the current medications used by smokers who are trying to quit. Please note that this guide may not include every medication available. All of these medications have been shown to be useful for helping smokers quit. There is no one medication that works best for all smokers. Always read the instructions on the package carefully and talk with your doctor or pharmacist if you have questions. The dosing information below is meant only to show how most people use these medications. The dose of your prescription medications must be decided by a doctor. If you are pregnant, breastfeeding, or have a severe medical problem, talk with your doctor before starting any new medication.

First-Line Medications: Nicotine Replacement Therapy (NRT)
These medications are called "first-line" because many smokers use these when they first try to quit. If the first-line medications don’t work, they might try a "second-line" medication instead.

Nicotine replacement therapy (NRT) helps smokers quit by reducing their craving sensations. These craving sensations happen when the body goes through withdrawal from the nicotine in tobacco. NRT products provide controlled amounts of nicotine. Individuals reduce their use of NRT products over time, allowing their bodies to gradually adjust to increasingly lower nicotine levels.

First-Line Medications: Nicotine Replacement Therapy (NRT)

First-Line Medications: Other

Second-Line Medications

Nearly 70 percent of adult smokers want to quit smoking, according to a national survey. Conventional quit-smoking treatments, including counseling and medication, can double or triple the chances that a smoker will kick the habit successfully. For more information on quitting smoking, visit smokefree.gov, the National Cancer Institute’s quit-smoking resource.

Some people also try complementary health approaches to help them quit smoking. Here are 5 things you should know about what the science says about several complementary health approaches for quitting smoking:

1. Current evidence suggests that several mind and body practices may help people quit smoking. A few studies have found that mind and body practices such as meditation-based therapies, yoga, and guided imagery (a relaxation technique) can help reduce cigarette use and cravings.
   
2. Research results on other mind and body practices, including acupuncture and hypnosis, show little evidence of benefit. A 2010 systematic review of the scientific literature concluded that hypnotherapy did not provide any greater effect on the rates of quitting than 18 other therapies or no treatment. A 2011 systematic review of acupuncture studies found no consistent evidence that acupuncture is effective for smoking cessation, but that firm conclusions can’t be drawn because of the limited quality and quantity of available evidence.
   
3. There is no current evidence that any dietary supplement helps people quit smoking. A few studies have been conducted on the dietary supplements S-adenosyl-L-methionine (SAMe), silver acetate, lobeline (from the herb Lobelia inflata), and St. John’s wort, but none has been shown to be effective. The natural product cytisine, primarily used in Central and Eastern European countries for smoking cessation, is not currently approved by the U.S. Food and Drug Administration (FDA) but has been shown to be effective in helping smokers quit.
   
4. The mind and body practices discussed here are generally considered safe for healthy people when they’re performed appropriately. If you have any health problems, talk with both your health care provider and the complementary health practitioner/instructor before starting to use a mind and body practice.
   
5. If you are considering a dietary supplement, remember that “natural” does not necessarily mean “safe.” Some supplements have side effects, and some may interact with drugs or other supplements to produce adverse effects. In particular, St. John’s wort has been shown to interact with many drugs.

Having cravings for a cigarette is one of the most common symptoms of nicotine withdrawal when you quit smoking. It helps to have a plan to manage cravings when they hit. Including exercise in your plan can help you get past cravings.

Exercise can distract you and keep you busy until the craving passes.

Exercise has other benefits too:

• Studies show that even short periods of physical activity, especially aerobic exercise, reduce the urge to smoke. Aerobic exercise is physical activity that makes you sweat, causes you to breathe harder, and gets your heart beating faster. It strengthens your heart and lungs. Walking, swimming, running, dancing, cycling, and boxing are a few types of aerobic exercise.
• Withdrawal symptoms and cravings for cigarettes decrease during exercise and up to 50 minutes after exercising.
• Exercise decreases appetite and helps limit the weight gain some people have when they quit smoking.
• Exercise helps you cope with stress and have more energy.
• Exercise can improve your mood. If you’re feeling low, take a walk, jump rope, or run up and down the stairs.

Fact: Exercise boosts your endorphins, gives you time to clear your head, and makes you feel great.

Get Physical!

Here are some tips to get you started with exercise and help you ride out cravings:

• Try to set aside a regular time for exercise that works with your schedule.
• Try for 30 minutes of physical activity most days of the week. Don’t have 30 minutes? Studies show that exercising for 10 minutes three times a day gives the same benefits as 30 minutes of non-stop exercise.
• Do activities you enjoy. Walking is one way of getting more physical activity. You might also think about biking, swimming, dancing, or yoga. Even housework or gardening can provide exercise benefits. Playing music while you clean out your closets will help you step up the pace.
• Build exercise into other activities. Take the stairs at work instead of the elevator. At the mall, use the stairs instead of the escalator. Wherever you go, park your car farther away and walk to your destination.
• Plan activities with family, friends, or co-workers that include physical activity. Maybe a hike or volleyball game.
• Change your exercise routine or try a new activity from time to time so you don’t get bored.

Try getting moving, even for just a few minutes, to get through a craving.

Try some yoga. It increases oxygen to the brain, lowers stress, calms nerves and improves your mood!

Nicotine withdrawal is different for every smoker. Every smoker feels different during withdrawal.

The most common symptoms include:

• Having cravings for cigarettes
• Feeling down or sad
• Having trouble sleeping
• Feeling irritable‚ on edge‚ or grouchy
• Having trouble thinking clearly and concentrating
• Feeling restless and jumpy
• Having a slower heart rate
• Feeling more hungry or gaining weight

You may have tough days and easy days with these symptoms. Over time, the symptoms and cravings will fade as long as you stay smokefree. Medications and changing the things you do can help you manage withdrawal symptoms.

Nicotine Cravings

For many smokers, cravings for a cigarette last much longer than other symptoms of withdrawal. Many people are surprised when cravings sometimes happen without warning. Cravings can be set off by reminders of smoking. These reminders are often called triggers. People, places, and things can trigger a craving. This means it's important to have a plan for how you'll handle a craving when it hits.

The good news is that every craving will pass if you give it time and keep yourself busy. Finding ways to get through that period of time is a key way to deal with cravings. Anything that can distract you and keep you busy can be helpful. Getting active also can work. A short walk can help you distract yourself until the craving passes. Most smokers who try nicotine replacement therapy find it helpful for getting through withdrawal and managing cravings.

Nicotine Withdrawal Isn’t Dangerous

Withdrawal can be uncomfortable and some people may feel high levels of symptoms. But there is no health danger from nicotine withdrawal. In fact‚ quitting smoking is the best thing you can do for your health. Even extreme withdrawal symptoms will fade over time.

Some people feel increased sadness after they quit smoking. Watch for this, especially if you’ve ever had depression. If you become depressed or are having extreme sadness, let a friend or family member know, and think about talking to your doctor.