Quitting is not easy but you can do it. There are medicines that may help you quit.

There are products that help wean your body off the nicotine you get from cigarettes and tobacco. There are other medicines that help you deal with the cravings and other problems that you feel when you stop smoking.

Why Quit?

Quitting may improve your health and wellness. If you quit smoking, you may:

• lower your chance of dying of lung cancer
• improve your skin
• reduce bad breath

Some women also decide to quit for their children or family. Whatever your reasons for quitting, you have made the right choice.

Why is it so hard to quit?

Many people who smoke become addicted to the nicotine in cigarettes and other tobacco products. When you try to stop smoking, you might:

• crave cigarettes
• feel nervous
• feel irritable (cranky)
• have headaches
• have problems sleeping
• feel depressed

These may be signs of nicotine withdrawal. Talk to your health care provider about the medicines listed in this booklet that may help you deal with withdrawal.

Nicotine Replacement Products

Nicotine replacement products give your body nicotine without most of the other chemicals found in cigarettes and other kinds of tobacco. These products help you wean your body off tobacco and help you deal with withdrawal.

• Read the label and talk to your healthcare provider as needed about the right way to use each product.
• Ask how these products will affect your other medicines. Ask about the risks and side effects.
• Women who are pregnant or breastfeeding should only use nicotine replacement products if their doctor says that it is OK.

Other Medicines to Help You Quit

Some prescription medicines have been found to help people deal with the withdrawal symptoms they feel when they quit smoking. Talk to your healthcare provider about the benefits, risks, and side effects for each medicine.

Other Things to Consider

Before you take Chantix or Zyban, tell your healthcare provider if you:

• are pregnant or plan to become pregnant.
• are breastfeeding.

When trying to quit smoking with or without stop-smoking medicines, some people have significant side effects including new or worsening mental health problems such as:

• thoughts about suicide or dying
• attempts to commit suicide
• new or worse depression
• new or worse anxiety
• feeling very agitated or restless
• panic attacks
• trouble sleeping (insomnia)
• new or worse irritability
• acting aggressive, being angry, or violent
• acting on dangerous impulses
• an extreme increase in activity and talking (mania)
• other unusual changes in behavior or mood

These symptoms happen more often in people who had a history of mental health problems before trying to quit smoking than in people without a history of mental health problems.

• Stop taking Chantix or Zyban and call your healthcare provider right away if you, your family, or your caregiver notices any of these side effects.
• Before taking these medicines, tell your healthcare provider if you have ever had depression or other mental health problems. You should also tell your provider about any symptoms you had during other times you tried to quit smoking.
• Read the patient Medication Guide that comes with each new Chantix or Zyban prescription because the information may have changed. The Medication Guide explains the risks associated with the use of the medicine.

Quit Smoking Tips

Quit Smoking… for yourself and for those who need you.

1. Set a Quit Date
   • Pick a day in the next 2 weeks.
   • Plan fun activities for your quit day to take your mind off smoking and tobacco.
2. Tell your Friends and Family
   • Get help from the important people in your life.
   • Join a support group.
   • Call a quit smoking helpline.
3. Plan for Challenges and Setbacks
   • Plan ways to deal with cravings, withdrawal, and stress.
   • Do not give up.
   • Keep trying.
4. Remove all Cigarettes and Other Tobacco
   • Get rid of cigarettes and tobacco.
   • Throw out your matches, lighters, and ashtrays.
   • Clean your clothes and house to get rid of cigarette smell.
5. Talk to your Healthcare Provider
   • Talk to your doctor, nurse, or pharmacist about medicines to help you deal with nicotine withdrawal.
   • Ask if your other medicines will work differently now that you have quit smoking.

Quitting smoking is one of the most important actions people can take to improve their health. This is true regardless of their age or how long they have been smoking.

Quitting smoking:

• improves health status and enhances quality of life.
• reduces the risk of premature death and can add as much as 10 years to life expectancy.
• reduces the risk for many adverse health effects, including poor reproductive health outcomes, cardiovascular diseases, chronic obstructive pulmonary disease (COPD), and cancer.
• benefits people already diagnosed with coronary heart disease or COPD.
• benefits the health of pregnant women and their fetuses and babies.
• reduces the financial burden that smoking places on people who smoke, healthcare systems, and society.

While quitting earlier in life yields greater health benefits, quitting smoking is beneficial to health at any age. Even people who have smoked for many years or have smoked heavily will benefit from quitting.

Quitting smoking is the single best way to protect family members, coworkers, friends, and others from the health risks associated with breathing secondhand smoke.

Cardiovascular Health Benefits of Quitting Smoking

Quitting smoking is one of the most important actions people who smoke can take to reduce their risk for cardiovascular disease.

Quitting smoking:

• reduces the risk of disease and death from cardiovascular disease.
• reduces markers of inflammation and hypercoagulability.
• leads to rapid improvement in high-density lipoprotein cholesterol (HDL-C) levels.
• reduces the development of subclinical atherosclerosis and slows its progression over time.
• reduces the risk of coronary heart disease with risk falling sharply 1-2 years after cessation and then declining more slowly over the longer term.
• reduces the risk of disease and death from stroke with risk approaching that of never smokers after cessation.
• reduces the risk of abdominal aortic aneurysm, with risk reduction increasing with time since cessation.
• may reduce the risk of atrial fibrillation, sudden cardiac death, heart failure, venous thromboembolism, and peripheral arterial disease (PAD).

People already diagnosed with coronary heart disease also benefit from quitting smoking.

Quitting smoking after a diagnosis of coronary heart disease:

• reduces the risk of premature death.
• reduces the risk of death from heart disease,
• reduces the risk of having a first heart attack or another heart attack.

Respiratory Health Benefits of Quitting Smoking

Quitting smoking is one of the most important actions people who smoke can take to reduce their risk for respiratory diseases.

Quitting smoking:

• reduces the risk of developing COPD.
• among those with COPD, slows the progression of COPD and reduces the loss of lung function over time.
• reduces respiratory symptoms (e.g., cough, sputum production, wheezing).
• reduces respiratory infections (e.g. bronchitis, pneumonia).
• may improve lung function, reduce symptoms, and improve treatment outcomes among persons with asthma.

Cancer-Related Health Benefits of Quitting Smoking

Quitting smoking is one of the most important actions people who smoke can take to reduce their risk for cancer.

Quitting smoking reduces the risk of 12 different cancers, including:

• acute myeloid leukemia (AML)
• bladder
• cancer of the lung
• cervix
• colon and rectum
• esophagus
• kidney
• liver
• mouth and throat (oral cavity and pharynx)
• pancreas
• stomach
• voice box (larynx)

For cancer survivors, quitting smoking may improve prognosis and reduce risk of premature death.

Reproductive Health Benefits of Quitting Smoking

Quitting smoking is one of the most important actions women who smoke can take for a healthy pregnancy and a healthy baby. The best time for women to quit smoking is before they try to get pregnant. But quitting at any time during pregnancy can benefit mother and baby’s health.

Quitting smoking:

• before pregnancy or early in pregnancy reduces the risk for a small-for-gestational-age baby.
• during pregnancy reduces the risk of delivering a low birth weight baby.
• early in pregnancy eliminates the adverse effects of smoking on fetal growth.
• before pregnancy or early in pregnancy may reduce the risk of preterm delivery.

Health Benefits of Quitting Smoking Over Time

Over time, people who quit smoking see many benefits to their health. After you smoke your last cigarette, your body begins a series of positive changes that continue for years.

Reduced risks refer to cessation in comparison to continued smoking.

Your brain has to get used to not having nicotine around.

• Nicotine is the main addictive drug in tobacco that makes quitting so hard. Cigarettes are designed to rapidly deliver nicotine to your brain.
• Inside your brain, nicotinetriggers the release of chemicals that make you feel good. As nicotine stimulates parts of your brain over and over, your brain gets used to having nicotine around.
• Over time, nicotine changes how your brain works and makes it seem like you need nicotine just to feel okay.
• When you stop smoking,your brain gets irritable. As a result, you might get anxious or upset. You might have a hard time concentrating or sleeping, have strong urges to smoke, or just feel generally uncomfortable.
• These feelings are called withdrawal. This gets better a few weeks after quitting as your brain gets used to not having nicotine around.
• Some quit-smoking medicines contain nicotine. This gives you a safe way to get used to not having so much nicotine from cigarettes in your brain.

You have to get used to daily routines that don’t involve smoking.

• Your days are filled with routines that you associate with smoking. When you quit it may be hard for you to do these routines without a cigarette in your hand.
• Many people connect smoking with things they do during the day, like taking breaks, drinking a cup of coffee, finishing a meal, talking with friends, or using the phone. These are called triggers.
• Feelings can also trigger an urge to smoke. People can get urges when they start to feel stressed or down, or even when feeling happy or relaxed. Then when you quit, one of these feelings can trigger the urge to smoke.
• When you quit, you will figure out how to get through your routines without cigarettes. And you will figure out how to deal with feeling stressed or down without smoking.
• The good news is that millions of people have quit smoking for good, and most report feeling better after they’ve been quit for a while.

To quit successfully, you have to deal with both of these challenges: your brain not having nicotine, and not having cigarettes during your daily routines. It can be hard to deal with both at once:

• Quit-smoking medicines help with the first challenge by reducing cravings and withdrawal symptoms like being irritable and having trouble concentrating and sleeping. Learn more about how quit-smoking medicines work.
• That allows you to focus on the second challenge: figuring out how to get through the day doing all the activities you connected to smoking. The good news is there are lots of simple things you can do that make it easier.

There are seven U.S. Food and Drug Administration (FDA) approved medicines for adults to use when quitting smoking.

• In five of these medicines, nicotine is the active ingredient. Nicotine is the main addictive drug in tobacco that makes quitting so hard. The medicines with nicotine are called nicotine replacement therapies (NRTs). They include the nicotine patch, nicotine gum, nicotine lozenge, nicotine nasal spray, and nicotine inhaler.
• Two pill medicines (varenicline and bupropion) do not contain nicotine and help people stop smoking in other ways. For example, varenicline attaches to the same parts of the brain as nicotine, reducing the urge to smoke. Varenicline also makes cigarette smoking less pleasurable by blocking some of nicotine’s effects

All these medicines can help you quit smoking in three important ways:

• They make quitting less painful.
• Quit-smoking medicines are much safer than smoking.
• They help you get through the toughest times.

Quit-smoking medicines work best if you do these simple things:

• ✓ Take them for a long enough time—usually 6 to 12 weeks or longer, depending on the medicine.
• ✓ If using NRT, use enough to relieve your withdrawal symptoms and cravings. This can mean using two NRTs at once.
• ✓ Follow instructions on how to use them correctly.
• ✓ Get some coaching on tips and tools to quit smoking successfully.
  • Quit-smoking medicines are not “magic bullets” that guarantee you will quit. The good news is that there are lots of tips that help the medicines work even better and keep you quit!
  • Free coaching is also available, including by calling a quitline, such as 1-800-QUIT-NOW.
  • Your doctor or other healthcare professional can provide support and ideas for how to quit. They can also help you choose a medicine and give you advice on how to use it so that it really helps.

Let’s face it: quitting smoking can be hard, but it can be done!

Quit-smoking medicines can make quitting easier by reducing your withdrawal symptoms.

Think back to when you first began smoking cigarettes. You probably started as a teen or young adult. Most people don’t go from not smoking to smoking regularly overnight:

• The first few cigarettes you smoked probably made you feel uncomfortable. You may have had a coughing fit, or felt sick to your stomach. But you kept trying cigarettes.
• It took time for your brain to get used to the effects of nicotine, the powerful drug in cigarettes.
• You learned by experience how to smoke so your lungs didn’t hurt so much, and so you got enough but not too much nicotine.

Quitting smoking is the same thing in reverse:

• If you have smoked for a long time, you may experience uncomfortable and unpleasant moments as you get used to not having nicotine around anymore.
• This is called withdrawal, where you feel physically uncomfortable and may have a hard time concentrating or sleeping. You may feel anxious or irritable.
• In addition, many people have increased urges to smoke that can become hard to control.

When you quit you also have to figure out how to get through the day doing all the things you usually did, but now without a cigarette:

• The good news is that just like learning how to smoke when you were younger, you will learn how to not smoke over time.
• Withdrawal, urges, and getting through the day without smoking generally gets better a few weeks after quitting.

Getting through the hard times when quitting can be tough. Quit-smoking medicines can help. They can decrease the intensity of withdrawal and urges. This allows you to concentrate more on figuring out how to get through the day without cigarettes. Learn more about why quitting smoking is hard or about how quit smoking medicines work.

If you’ve used quit-smoking medicines before and felt like they did not help enough, there are new ways to use medicines that may help even more. These include using two NRT medicines at the same time or starting to use quit-smoking medicines before you try to quit. Learn more about new ways to use quit-smoking medicines.

All the quit-smoking medicines approved by the FDA have a long track record showing that they work and are safe to use. Despite this, some people still worry about their safety. Let’s talk about some of the concerns you might have.

Nicotine Replacement Therapy is safe to use.

Quit-smoking medicines containing nicotine (NRTs) do not cause death and diseases like cigarettes do. Most of the dangers of smoking are due to the hundreds of toxic chemicals in the cigarette smoke, not the nicotine.

• Using a nicotine medicine will not cause cancer like smoking.
• Using a nicotine medicine will not cause lung disease like smoking.
• Using a nicotine medicine is much less likely to cause heart disease than continued smoking.
• If you continue to smoke instead of using NRT, you will still be exposed to the hundreds of harmful chemicals in cigarette smoke. These chemicals include nitrosamines, which are formed by growing, curing, and burning tobacco. Nitrosamines cause many kinds of cancer and are found in cigarette smoke but NOT in NRT.

They make quitting less painful.Learn howQuit smoking medicines are much safer than smoking.They help you get through the toughest times.Learn more

NRT is much less addictive than cigarettes while still helping decrease your urge to smoke.

• Cigarettes are designed to get nicotine to your brain fast—as fast as 7 seconds! This can feel good and makes cigarettes hard to give up. NRT delivers less nicotine to your brain and much more slowly. This gives you a safe way to get used to not having so much nicotine from cigarettes around in your brain.

NRT reduces the uncomfortable feelings you get from nicotine withdrawal.

• The nicotine in tobacco changes how your brain works and makes it seem like you need nicotine just to feel okay. When you don’t smoke for a while, you may feel irritable, have trouble concentrating, or have difficulty sleeping. Using NRT helps with these problems, which can help you quit smoking for good.

Using NRT to quit smoking is usually temporary, generally recommended for 8 to 12 weeks.

• If you keep smoking instead, you will be exposed to the hundreds of toxic chemicals in cigarette smoke for much longer. The fact that NRT is used for a shorter time compared with continuing to smoke helps make NRT much safer than smoking. Plan on using NRT for at least 6 to 8 weeks. Stopping NRT too soon is a common mistake people make.

NRTs usually only cause minor side-effects such as skin rash with the patch, or upset stomach with the gum or lozenge. You do not usually need to stop a medicine because of a minor side-effect. Talk to your doctor if side-effects are more severe. There are a few special situations when NRT should not be used or must be used with caution after talking with your doctor.

• Pregnant women are encouraged to try to quit without medicines because nicotine may have effects on the developing baby. But if this doesn’t work, talk to your doctor or other healthcare professional about whether it is OK to use NRT. It is very important to quit smoking as soon as possible when pregnant.
• People who have had a heart attack in the last 2 weeks or have serious heart problems or chest pain should talk to their doctor before using NRT.
• You can also talk to your doctor if you have a medical condition or take a medication you think might affect your use of NRT.

Quit-smoking pills (varenicline or bupropion) are much safer than smoking.

Using either of the quit-smoking pill medicines is much safer than continuing to smoke.

• There is no evidence that quit-smoking pills cause cancer or lung disease.
• Using varenicline is recommended for 3 to 6 months. Bupropion is recommended for up to 3 months. If you keep smoking, you will keep getting exposed to the hundreds of harmful chemicals in cigarette smoke. Quit-smoking pills are used for a short time compared to continuing to smoke.

You will need to talk to a doctor to get varenicline or bupropion because you’ll need a prescription.

• Your doctor will review your medical history to help figure out if a prescription is right for you, which medicine to use, and how to use it safely. For example, you may be asked if you have depression, heart disease, epilepsy, or other chronic health conditions.

More information is available about precautions and side-effects for varenicline and bupropion. Quit-smoking pills can cause some minor side-effects like nausea.

Quit-smoking medicines can more than double your chance of success.

Three approaches are especially effective and give you the best chance at quitting:

• Using two NRT medicines together—the nicotine patch and a faster-acting one like the lozenge or gum.
• Using varenicline as a single medicine—provides the highest success rate of any single medicine, reducing urges and your enjoyment of smoking.
• Using coaching in addition to your quit-smoking medicine.

The first couple of days of quitting are usually the most difficult. And the first few weeks are often tough. But don’t give up! Quit-smoking medicines can help get you through these hard times and the times ahead. And they’ve been proven to reduce the chance that you’ll go back to smoking while you use them.

Quit-smoking medicines work best if you do these simple things:

• ✓ Take them for a long enough time—usually 6 to 12 weeks or longer, depending on the medicine.
• ✓ If using NRT, use enough to relieve your withdrawal symptoms and cravings. This can mean using two NRTs at once.
• ✓ Follow instructions on how to use them correctly.
• ✓ Get some coaching on tips and tools to quit smoking successfully.
  • Quit-smoking medicines are not “magic bullets” that guarantee you will quit. The good news is that there are lots of tips that help the medicines work even better and keep you quit!
  • Free coaching is also available, including by calling a quitline, such as 1-800-QUIT-NOW.
  • Your doctor or other healthcare professional can provide support and ideas for how to quit. They can also help you choose a medicine and give you advice on how to use it so that it really helps.

How does Nicotine Replacement Therapy work?

• Nicotine Replacement Therapy (NRT) works by replacing some of the nicotine you used to get from cigarettes, so you don’t feel as uncomfortable after quitting.
• There are five different NRTs approved by the U.S. Food and Drug Administration for quitting smoking.
  • Nicotine is the active ingredient in all of them.
  • Nicotine patches, gum, and lozenges are the most common quit-smoking medicines, and you can buy them without a prescription (over-the-counter).
• NRTs supply nicotine without the hundreds of harmful chemicals that cigarette smoke contains.
• NRT helps lessen the uncomfortable feelings that come when you stop getting nicotine from cigarettes.
  • When used as directed, most people get enough nicotine from NRT to avoid having overwhelming cravings and withdrawal symptoms.
  • However, even using quit-smoking medicine you will likely still have some discomfort and urges to smoke.
  • The good news is there are many ways you can get help dealing with these.
• Using the long-acting patch at the same time as a short-acting NRT, like the lozenge or gum, can help decrease withdrawal even more. Learn more about ways to use a combination of medicines.
• You can gradually decrease the amount of nicotine that you get from NRT over several weeks. Your brain will get used to working without so much nicotine. And you will figure out how to get through the day without smoking.

How do quit-smoking pills work?

There are two quit-smoking medicines approved by the U.S. Food and Drug Administration that are pills:  bupropion and varenicline.

• Bupropion has many effects on the brain, including helping people quit smoking. It decreases craving and other nicotine withdrawal symptoms.
• Varenicline has two main effects:
  • It mimics some of the effects that nicotine has on parts of your brain, reducing your urge to smoke and some withdrawal symptoms.
  • It reduces the enjoyment you get from the nicotine in cigarettes. This can make it easier to quit and stay quit. It does this by attaching strongly to the same parts of your brain that nicotine attaches to, but without stimulating them as strongly as nicotine. This means that nicotine from a cigarette has fewer places to attach because the varenicline is already there. In other words, varenicline makes it harder to get a nicotine “buzz.”

Most people who smoke have tried to quit many times. Maybe it feels like you’ve tried everything and nothing worked. We’ve got some good news! We now know much more about what works best to help people quit smoking. Here are five new ways to quit that are proven to work for adults. They can help make quitting easier, less painful, and more successful.

1) Using more than one medicine can help a lot.

Nicotine patch plus lozenge or gum is the most common combination.

How to use two NRTs together:

• Put on a new patch each morning to get a steady level of nicotine that will reduce your cravings and withdrawal symptoms throughout the day.
• Use a fast-acting nicotine medicine like lozenges or gum to quickly combat cravings.
• You can control how often you use the fast-acting medicine, so you won’t get more nicotine than you want.
• This combination is easy to use. Using two NRTs together can help you quit more successfully than using a single medicine.

2) One non-nicotine medicine is especially effective.

Varenicline works to help people quit.

Varenicline is a pill that works differently from other medicines. It does not contain nicotine. It works by attaching to the same parts of your brain that are stimulated by nicotine. This means that nicotine from a cigarette has fewer places to attach because the varenicline is already there. This makes it harder to get a nicotine “buzz.”

Varenicline:

• Reduces your urge to smoke and enjoyment of cigarettes.
• Gives you the strongest chance for success of any single medicine.
• Is started a week or more before you quit smoking.

How Varenicline Can Help You Quit Smoking

3) You can increase your chance of success when using quit- smoking medicine:

Get some free coaching to help you quit.

Wondering which quit-smoking medicine to use, or which dose to start with? Having problems with a medicine and not sure what to do?

Talking with a quit coach or a healthcare professional such as your doctor or pharmacist, will help you get the most out of the medicines you are using. You can also get other tips about ways to deal with urges to smoke.

Check out this sampler of tips that a coach can provide to help you.

There are many ways to get help quitting:

✓ Call 1-800-QUIT-NOW.

When you call a quitline, you will be connected to a quit coach who has been trained to provide you with the best quitting tips and tools, and to listen to and support you. Best of all, it’s free, and sometimes quit coaches can help you get free quitting medications as well. Here are 5 reasons calling a quitline can be key to success.

✓ Talk with your doctor or other healthcare professional.

Your doctor will be glad to hear you are interested in quitting. You can ask them for encouragement, suggestions, prescriptions if needed, and referral to other support resources. They can also share with you how quitting smoking will dramatically benefit your health.

✓ Check out free web, texting and app programs.

Enrolling in a texting program, downloading an app, or using a website designed to support quitting can help you succeed. The web pages you are using now are another example. Many quitlines offer similar services.

✓ Find a class or one-on-one counseling.

Group classes and one-on-one counseling may be available in your community and can help with quitting. You can check with your doctor or another healthcare professional, your health insurer, or call 1-800-QUIT-NOW and ask about local resources.

4) Get quit-smoking medicines for free or reduced cost.

If you have health insurance:

• Most health insurance plans cover FDA-approved quit-smoking medicines, including over- the-counter medicines.
• Even if you want to use an over-the-counter medicine, you may need to get a prescription from your doctor in order to have your insurer cover it.
• If you aren’t sure how to get them for free or reduced cost, talk to your pharmacist or call the number on your insurance card. You can also call 1-800-QUIT-NOW where a quit coach can help you connect with quit-smoking medicines.

If you don’t have health insurance:

• Call 1-800-QUIT-NOW to ask about free or reduced-cost quit medicines.
  • Quit coaches can help connect you with quit-smoking medicines through community programs. Some states have special programs for people who smoke and don’t have health insurance.
  • They may also be able to provide you with free medicines directly, for example by sending some nicotine patches, lozenges, or gum to your home.
• Try shopping around or using discount coupons. You may be able to buy nicotine patches, for example, for much less than the cost of a pack of cigarettes!
• Look online or ask your pharmacist if they know about any discount programs you may be eligible for.
• Once you quit, you’ll save the money you used to spend on cigarettes!

Other ways you can save money on medicines:

• ✔ Let your doctor or pharmacist know that cost is an issue for you. They may be able to help you choose a lower-cost type of medicine that will still work.

• ✔ Shop around for the lowest price. Prices for the same medicine can be very different from store to store or brand to brand.

• ✔ Find discount coupons and price information online or ask your pharmacist. Remember that the prices you see online may be different from what you would actually pay if you have insurance coverage.

• ✔ Once you quit smoking, you will save the money you were spending on cigarettes. Quit- smoking medicines often cost less than cigarettes, and you won’t use the medicines forever. Here is a savings calculator so you can figure out how much you’ll save when you quit.

• ✔ Buy a larger supply. Many quit-smoking medicines are discounted if you buy more. Buying a larger supply of medicine may also help you stay committed to using the medicine for longer and may help you stay quit.

5) You can start taking some medicines before you quit.

1. It’s OK to start nicotine patches, gum, or lozenges a week or two before you quit smoking. This can help you get ready and may cut down on your smoking.
   • Starting medicine, especially the nicotine patch, before you quit may improve your chances of quitting successfully.
   • If you start NRT while still smoking, it is important that you do so as part of an effort to quit completely, preferably in a week or two after starting the medicine.
2. Quit-smoking pills (varenicline or bupropion) are recommended to be started a week and more before quitting. Your doctor will discuss the best time to start when you get your prescription.

There are seven medicines approved by the Food and Drug Administration (FDA) to help you quit. They work in different ways. All have been shown to be safe and effective for adults who smoke cigarettes.

There are also new ways to use them that can help them work even better. For example, you can use some medicines together, or you can work with a coach or counselor to help you get the most out of using medicine. You may be able to get quit-smoking medicines for free or reduced cost.

Certain medicines may not be right for some people with serious medical conditions. You can learn more about precautions and side-effects by clicking the above boxes, and on the links to webpages with information from the FDA for each medicine provided. Check with your doctor, pharmacist, or other healthcare provider if you have problems you think might be because of a medicine you are taking. If you start feeling down or depressed, it is especially important to talk to them right away. Some symptoms you experience when you quit smoking may be due to withdrawing from the nicotine in cigarettes, not from the quit-smoking medicine.

The quit-smoking medicines talked about on this website are approved by the FDA for adults to use to quit cigarettes. If you are pregnant, breastfeeding, or younger than 18, you should not use these medicines without talking to your doctor. If you use tobacco products other than cigarettes (such as cigars, chew, snuff, hookah, or e-cigarettes), talk to your doctor or other healthcare provider, or call the quitline (1-800-QUIT-NOW) to get help with quitting.

It is a good idea to check in with your doctor, healthcare provider, pharmacist, or quitline for help quitting and to get more advice about quit-smoking medicines.

Many people use quit smoking medications to help reduce withdrawal feelings and cigarette cravings. Quit smoking medications can double your chances of quitting for good.

Nicotine replacement therapy (NRT) is the most commonly used family of quit smoking medications. NRT reduces withdrawal feelings by giving you a small controlled amount of nicotine─but none of the other dangerous chemicals found in cigarettes. This small amount of nicotine helps satisfy your craving for nicotine and reduces the urge to smoke. 

Doctors and other medical experts think NRT is the one of the most helpful tools smokers can use to quit. Some smokers have mild to moderate side effects. However, research shows that NRT is safe and effective. NRT can be an important part of almost every smoker’s quit smoking strategy.

NRT comes in a variety of forms that are used in different ways. You can choose which forms you like best. Some NRT products work better than others for some people. Some people might prefer certain NRT products instead of others.

Types of NRT

Combining NRT with Other Strategies

NRT can’t do all the work. It can help with withdrawal and cravings, but it won’t completely take away the urge to smoke. Even if you use NRT to help you stop smoking, quitting can still be hard. Combining NRT with other strategies can improve your chances of quitting and staying quit. A personalized quit plan can help you find tools and strategies that work together to help you quit and stay quit. It can also help you to stay focused, confident, and motivated to quit.

To give yourself the best chance for success, explore other quit methods you can combine with medication.

Varenicline is a pill you take twice a day. You start taking it at least one week before you quit, gradually increasing the dose. It does not contain nicotine, so it works differently than the nicotine replacement medicines.

Pros:

• Simple to use so may be easier to stick with it.
• Your chance of successful quitting with a single medicine is best with varenicline.
• Varenicline gets in the way of nicotine in the brain so you don’t enjoy nicotine as much if you use a cigarette.
• Can gradually reduce your smoking, since you start taking it before quitting.

Cons:

• Need to take it with food or a full glass of water to help avoid nausea.
• May cost more if you have to pay for it yourself.
• Requires a prescription.

Possible Side Effects (talk to your doctor or other healthcare provider about what you can do):

• Nausea or vomiting at full dose (take with food or a glass of water. If persists, talk to your doctor about lowering the dose).
• Sleep disturbances such as difficulty sleeping and vivid dreams (talk to your doctor about lowering your evening dose).
• Constipation or flatulence (talk to your healthcare provider about diet changes or over-the-counter medicines you can take).
• Changes in your mood or behavior (rare – see precautions)

Varenicline Precautions (If any of these apply to you, talk to your doctor or other healthcare provider before starting to take varenicline.):

• Severe kidney problems (dose may need to be lowered).
• Could be pregnant or are breastfeeding.
• Less than 18 years old.

In addition, if you decide to take varenicline and experience hostility, agitation, depression, suicidal thoughts, or changes in how you act that you don’t think are due to quitting smoking, you should stop taking the medicine and talk to your doctor right away.

Bupropion is a pill you take twice a day. You start it 1-2 weeks before quitting. It does not contain nicotine, so it works differently than nicotine replacement medicines.

Pros:

• Simple to use so may be easier to stick with it.
• May help delay weight gain associated with quitting.
• If you have depression, it may help.
• Can be combined with nicotine patches under the care of your doctor or other healthcare provider.

Cons:

• More possible side-effects than other medicines.
• Cannot be used if you have ever had bulimia or anorexia, a seizure disorder, or are taking or recently quit taking an MAO inhibitor medicine. They are sometimes taken for depression. Check with your pharmacist or doctor if you are unsure.
• Requires a prescription.

Possible Side Effects (talk to your doctor or other healthcare provider about what you can do for these):

• Nausea, dizziness (try taking with food, drink plenty of water).
• Difficulty sleeping (take evening dose in late afternoon at least 8 hours after morning dose).
• Constipation, dry mouth (drink plenty of water, try sugarless gum).
• Rash (stop taking and talk to your doctor).
• Low risk of seizures (one person in a thousand – stop taking and talk to your doctor immediately).
• Nervousness, difficulty concentrating (talk to your doctor).
• Changes in your mood or behavior (rare – see precautions).

Bupropion SR Contraindications and Precautions (If any of these apply to you, talk to your doctor or other healthcare provider before starting to take bupropion.):

• A history of seizures.
• Already using bupropion for another reason.
• A history of bulimia or anorexia.
• Abruptly stopping use of sedating medicines or alcohol while taking bupropion.
• Taking or recently quit taking a type of medicine called an MAO inhibitor.
• Taking a medicine that makes you more prone to seizures.
• Liver disease.
• Could be pregnant or are breastfeeding.
• Less than 18 years old.

In addition, if you decide to take bupropion and experience hostility, agitation, depression, suicidal thoughts, or changes in how you act that you don’t think are due to quitting smoking, you should stop taking the medicine and talk to your doctor right away.

How much do you smoke?

Fewer than five cigarettes a day, or only smoke on some days?

• Consider using the nicotine lozenge or nicotine gum as needed. You can also consider quitting without medicine since there is less evidence medicine helps in your situation.

Between five and 19 cigarettes a day?

• Using any of the seven FDA-approved medicines can work for you. 

A pack of cigarettes or more a day?

• Using the patch along with the lozenge or gum can help. The patch provides a steady dose of nicotine to reduce withdrawal. The lozenge or gum is used as needed to control cravings. Also make sure you use a high enough dose.
• Another option to consider is using the pill varenicline, which cuts down on the enjoyment you feel when you smoke a cigarette and has a high success rate.

Do you want a quit-smoking medicine that…

Gives you the strongest chance of quitting and staying quit?

• If so, there are two easy-to-use ways that help the most:
  • The first is using the nicotine patch together with lozenge or gum.
  • The second is using the pill varenicline.
• You can also talk with your healthcare provider about other combinations of quit smoking medicines that may improve your chances of quitting for good.

Is simple to use?

• Consider using the nicotine patch or one of the pills (varenicline or bupropion). These medications are used only once or twice a day, so you don’t have to think about how often to take them. 

Might delay possible weight gain associated with quitting?

• The nicotine lozenge, nicotine gum, and bupropion can help delay weight gain associated with quitting.
• You can learn ways to keep your concern about gaining weight from undermining your quit attempt by talking with a quit coach.

Gives your mouth something to do, as a substitute for cigarettes?

• Consider nicotine gum, lozenge, or oral inhaler.

Allows you to decide how much nicotine you get and when?

• If you want a medicine you can use right when you have an urge or craving, consider the nicotine lozenge, gum, oral inhaler, or nasal spray.

When you tried to quit before without quit-smoking medicines…

Did you really struggle with withdrawal, including overwhelming urges and cravings?

• Consider using quit-smoking medicines to help reduce your withdrawal symptoms. Using a combination of patch plus gum or lozenge might work well for you.

Did you sneak puffs on cigarettes and then quickly relapse?

• Consider using varenicline, which cuts down on the enjoyment you feel when you smoke a cigarette.

When you tried to quit before with quit-smoking medicines…

Did the medicine help you quit successfully for a month or more?

• Consider using the same medicine.

Did you find that you didn’t like the medicine, or were not able to quit?

• Think carefully about what problems you had with the medicine you used. Sometimes people don’t use a medicine correctly, don’t use a strong enough dose, or don’t use the medicine long enough.
• If none of these apply to you and you didn’t like using the medicine, consider using a different FDA-approved quit smoking medicine.

How long have you stayed quit?

Did you stop smoking for a month or more and then went back to smoking?

• You may be able to quit the same way again. Talking with a quit coach can help you find strategies that will help you stay quit. You can call the quitline (1-800-QUIT-NOW) to learn more about how to keep from relapsing.

Did you have a hard time staying quit for more than a few days?

• A quit-smoking medicine could help you. You can try using a medicine for a week or two before quitting. Doing this can decrease the rewards you get from smoking, which may make it easier to quit completely. You may find you cut down on your smoking. Varenicline and bupropion are usually started before you quit, and it is also OK to do this with the nicotine patch, gum, or lozenge. Also consider combining the nicotine patch with lozenge or gum for even more help addressing withdrawal symptoms.

What are you most worried about when you quit?

How to deal with cravings and urges?

• All the medicines help some with this. If you want a medicine that will help you right away when you have an urge or craving, consider the nicotine lozenge, gum, inhaler, or spray.
• Using the patch along with the lozenge or gum may help even more. The patch provides a steady dose of nicotine to reduce withdrawal symptoms. The lozenge or gum is then used as needed to control cravings.

Having to stop smoking all at once?

• It’s OK to start nicotine patches, gum, or lozenges a week or two before you quit smoking. Doing this can decrease the rewards you get from smoking which may make it easier to quit. Starting a medicine early may even help you cut down on your smoking before you start your quit attempt. Quit smoking pills (varenicline and bupropion) are usually started a week or more before quitting.

Gaining weight while you quit?

• The nicotine lozenge, nicotine gum, and bupropion can help delay weight gain associated with quitting.
• You can learn ways to keep your concern about gaining weight from undermining your quit attempt by talking with a quit coach.

Do any of these apply to you?

You are pregnant or breast-feeding?

• It is great you want to quit smoking. It is one of the most important things you can do for your baby at any stage of your pregnancy. The sooner you quit, the better.
• You need to be very careful which medicines you use while pregnant or breastfeeding, including quit-smoking medicines. You should not use quit-smoking medicines without first talking with your doctor, nurse practitioner or midwife.
• E-cigarettes are not safe to use during pregnancy. They contain nicotine and can be harmful to your developing baby.

Whatever approach you choose, quitting smoking is key. Smoking is very dangerous for developing babies. Don’t put off quitting!

You are younger than 18?

• It is great you want to quit smoking. There are many things you can do to be successful when you quit.
• If you want to use a quit-smoking medicine when you quit, you will need to talk with your doctor or other healthcare provider.

Using any of the 7 FDA-approved medicines will help you quit.

Talking with a quit coach, a healthcare provider such as your doctor, or a pharmacist will help you get the most out of the medicines you are using. They are experts who want you to succeed.

Pros:

• Getting coaching support while using a medicine increases your chance of quitting.
• Coaches can give you other tips about ways to deal with urges to smoke and other challenges you may face quitting.
• Coaches can help you choose and use a medicine the right way.
• Coaches may have ideas about how you can lower the cost of getting medicine. Many insurance companies cover some or all of the costs of quit-smoking medicines, and some quitlines provide free or reduced-cost medicine “starter kits” from time to time.
• Coaches can help you solve problems you’re having with quitting or with a medicine you’re using.
• Some coaching is free, such as calling 1-800-QUIT NOW.
• Coaching is confidential.

Cons:

• It takes some time to contact and get help talking with a quit coach or healthcare provider.

Possible Side Effects (and what you can do about them):

• None.

There are many ways to get help quitting:

✓ Call 1-800-QUIT-NOW

When you call a quitline, you will be connected to a quit coach. They have been trained to support you by listening and providing quitting tips and tools. Best of all, it’s free, and sometimes quit coaches can help you get free quitting medications as well. Many quitlines also offer digital support, including texting and web-based programs. Here are 5 reasons calling a quitline can be key to success.

✓ Talk with your doctor or other healthcare professional.

Talk with your doctor or other healthcare provider: Your doctor will be glad to hear you are interested in quitting and will support you in your quit attempt. You can ask them for encouragement, suggestions, prescriptions if needed, and referral to other support resources. They can also share with you how quitting smoking will dramatically benefit your health.

✓ Check out free web, texting and app programs.

Check out free web, texting, and app programs: Enrolling in a texting program, downloading an app, or using a website designed to support quitting can help you succeed. The web pages you are using now are another example.

✓ Find a class or one-on-one counseling.

Find a class or one-on-one counseling: Group classes and one-on-one counseling may be available in your community and can help with quitting. You can check with your doctor or other healthcare provider, your health insurer, or call 1-800-QUIT-NOW and ask about local resources.

You may be considering quitting smoking “cold turkey” without using a medicine. Some people who decide not to use a quit-smoking medicine just stop smoking right away, others cut back on how many cigarettes they smoke for a few weeks before quitting completely. Some people quit on their own, others get help and support from a quit coach or their doctor or other healthcare provider.

Pros:

• Don’t have to spend any money on medicines.
• Don’t have to see your doctor or go to a pharmacy.
• There is no risk of medication side effects.

Cons:

• Most people who quit without medicines experience worse withdrawal symptoms.
• You may have to deal with stronger and more frequent urges and cravings.
• If you smoke a half a pack a day or more, you are less likely to succeed at quitting for good.

Possible side effects (and what to do about them):

• You are likely to have worse withdrawal symptoms, including: Urges and cravings to smoke, feeling irritated or upset, feeling jumpy and restless, having a hard time concentrating, having trouble sleeping, feeling hungrier or gaining weight, and feeling anxious, sad or depressed. (Learn some tips that can help you deal with these)

If you are thinking about quitting without using a medicine, strongly consider talking with a quit coach or your doctor for help dealing with urges and cravings.

You are especially likely to benefit from using a medicine if you smoke a half a pack of cigarettes or more a day, struggled with urges and cravings when you tried to quit before, or have never stayed quit for more than a week.

If quitting is harder than you expected when you try, you can revisit using medicines to help. You don’t even have to wait until you smoke a cigarette to do this. You can keep nicotine gum or lozenges on hand, just in case you find that urges and cravings are stronger than you expected.

Quitting smoking may make some people depressed or anxious, whether quitting with medication or not. If you have feelings of depression or anxiety lasting for more than two weeks or that get worse, you should get help. Talk to your doctor and seek appropriate emergency help.

• Sometimes people who are feeling depressed think about hurting themselves or dying. If you or someone you know is having these feelings, get help now.
• Call or text the National Suicide Prevention Lifeline at 988, available 24 hours a day, 7 days a week.
• Call 911 or go to the nearest hospital emergency department for emergency medical treatment.
• Don’t be alone. Don’t leave another person alone if they are in crisis.

1. Using some medicines together can help a lot.
   • The nicotine patch can be combined with short-acting medicines like the nicotine gum, lozenge, inhaler, or spray to better relieve withdrawal symptoms and combat cravings.
2. Use the right amount of medicine.
   • Some medicines come in different doses. Picking the right dose is important to make sure your body gets the right amount of nicotine to help relieve withdrawal symptoms. Use the nicotine replacement medicine dosing tool to help you pick the right starting dose and talk with your healthcare provider for more help with dosing.
3. Use the medicines for a long enough time.
   • Many people don’t use quit-smoking medicines for long enough. Most medicines are most effective when used for 6 to 12 weeks or longer, depending on the medicine and your quit plan. Using the medicines for long enough can improve your chances of quitting for good.
4. Get some coaching to help you quit.
   • Looking for ways to deal with urges and cravings? Wondering how to manage situations that make you feel like smoking again? Having problems using a medication and not sure what to do? Connect with your state tobacco quitline (1-800-QUIT-NOW) for free coaching and support or talk with your healthcare provider. Combining medication with coaching support will give you the best chance to quit for good.
5. Start some quit-smoking medicines before you quit.
   • It’s OK to start nicotine patches, gum, or lozenges a week or two before you quit smoking. This can help you get ready and may help you cut down on your smoking before you start your quit attempt. But be sure to quit in a week or two.
   • Quit-smoking pills (varenicline and bupropion) should usually be started a week or more before quitting. Your prescribing healthcare provider will discuss the best time to start when you get your prescription.
6. Make sure you use your medicine correctly.
   • Did you know the nicotine gum isn’t used like regular chewing gum, the nicotine lozenge isn’t used like a hard candy, and the nicotine oral inhaler isn’t used like an asthma inhaler? For the best chance of quitting, learn how to use your medicine correctly. Read the medication label and explore below for tips.