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NC Department of Health and Human Services
NC DPH: Chronic Disease and Injury Section
N.C. Public Health Home

Tobacco Prevention and Control Branch

Medication Resources for Quitting Tobacco

Nicotine is a powerful drug and the addiction to it is difficult to break. There are, however, many products on the market – both over-the-counter and by prescription – to help you quit, and many people have found them to be useful. These products are described here, along with their benefits and side effects. As with all types of medication, it is important to follow your doctor’s advice and use products only according to the label, or as prescribed.

Nicotine Replacement Therapy (NRT)

If you are 18 or older you can buy NRT without a doctor’s prescription. If you are on Medicaid, NRT is covered if you have a prescription from a doctor. Your insurance provider may have similar benefits. NRT comes in different doses. When you have been off tobacco for awhile, you should be able to decrease the dose of NRT as your craving for nicotine lessens. You may want to keep backup NRT with you for at least a year, however, in case you have a sudden urge or craving. Always read the package instructions before using any form of NRT.

If you have had a recent heart attack, chest pain or serious abnormal heart beats, you should check with your doctor before using any NRT product.

If you are pregnant or breast-feeding, you should talk with your doctor before using NRT. If you can, it’s best to try quitting tobacco use without medications. The drug Chantix has not been studied in pregnant or nursing women and is not recommended for them.

The following list is an overview of some medications that might help you quit using tobacco.

Over the Counter Products

Nicotine Patch

The patch doesn’t work as fast as a cigarette, but after a few hours, it will work all day. You put it on just like a band-aid, and nicotine enters the body by passing through the skin. The patch comes in three different doses, and when you use the correct dose, you may have fewer withdrawal symptoms such as stress, bad temper, drowsiness and difficulty staying focused.

Nicotine Gum

Nicotine gum gets nicotine to the brain more quickly than the patch, but it still takes several minutes before the craving is relieved.

Nicotine gum is not chewed like ordinary gum. For the gum to work correctly, you must chew it only until it feels slightly tingly or peppery. Then “park” the gum between your cheek and gum to allow the nicotine to enter your bloodstream through the cheek lining. If you continue to chew nicotine gum beyond the peppery/tingly feeling, the nicotine will be swallowed instead of absorbed, the craving for tobacco will not be relieved, and you might end up with a stomachache.

When the next craving occurs, “chew and park” again. Continue to “chew and park” until chewing no longer results in the peppery/tingly feeling. Then begin again with a new piece. Nicotine gum is available in two doses.

Nicotine Lozenge

Nicotine lozenges come in the form of hard candies that you allow to melt slowly in your mouth. The lozenge releases nicotine into the bloodstream through the lining of the mouth and lasts about 20 to 30 minutes. Nicotine will continue to enter the bloodstream for a short time after the lozenge has melted completely.

Nicotine lozenges are available in two different strengths based on when you smoke your first cigarette of the day.

Prescription Products

Nicotine Inhaler

The nicotine inhaler is a plastic mouthpiece with a nicotine-filled cartridge that mimics the look and feel of smoking a cigarette. The inhaler is used whenever you crave a cigarette, but when you inhale, it delivers nicotine into the mouth instead of the lungs.

The inhaler delivers nicotine more slowly to the body than a cigarette, but it is often very helpful for someone who has a strong hand-to mouth association with cigarettes. A dose is one puff, and it takes about 80 puffs to equal the amount of nicotine in one cigarette. You should use no more than 16 cartridges per day for up to 6 months, cutting down during the last 3 months. Best effects are achieved by frequent puffing.

Nicotine Nasal Spray

Nicotine nasal spray is released from a pump bottle into the nose where the nicotine is rapidly absorbed through nasal membranes. With the spray, nicotine reaches the blood stream faster than other NRT products and can be most helpful for highly-addicted tobacco users.

A dose is two sprays – one in each nostril, best delivered with the head tilted slightly back. To avoid side effects, do not sniff, swallow or inhale while taking a dose.

Non-NRT Prescription Pills for Quitting

Buproprion Hydrochloride (Zyban, Wellbutrin)

Buproprion, or Zyban, was approved by the Food & Drug Administration in 1997 to help smokers quit. The drug is also sold as an antidepressant under the name Wellbutrin. You begin taking Zyban while you are still smoking, one to two weeks before your quit date.

Varenicline Tartrate (Chantix)

The drug Chantix works in two ways: first, by reducing the pleasure of smoking; and second, by lessening withdrawal symptoms. Start Chantix one week before your quit date. If you have a prescription for Chantix, you can access their support program on-line.

Note: Some patients have reported depressed mood, agitation, changes in behavior, suicidal thinking or behavior when attempting to quit smoking while taking Chantix. If you experience any of these symptoms, or if your family or caregiver observes these symptoms, please tell your doctor immediately. If you have ever had depression or other mental health problems, tell your doctor before taking Chantix.