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What are my options for OTC and prescription smoking cessation drugs

Ramzi Yacoub, Pharm.D. By | Updated on June 4, 2020

We value pharmacists at SingleCare, and we recognize how important they are to your healthcare team. That’s why we launched our Pharmacist Knows Best series. Each month our in-house pharmacist, Ramzi Yacoub, Pharm.D., will educate us about medications, health, or wellness topics the average person should know about. After all, pharmacists do know best! 

It’s never too late to quit smoking. Your risk for disease and early death is greatly reduced when you stop. There are health benefits at any age—and the sooner you stop, the greater they are. 

There are many different effective smoking cessation drugs to help you kick the habit. It’s important to find the stop smoking aid that works best for you and that will help you give up cigarettes for good. 

RELATED: Does smoking increase your risk of getting COVID-19?

Why is it so hard to quit smoking?

Nicotine is the primary substance in tobacco products that causes addiction. When you try to quit smoking, you may have symptoms of nicotine withdrawal because your body is dependent on the effects of nicotine. Common symptoms of nicotine withdrawal include irritability, anxiety, trouble sleeping, and increased appetite. The discomfort they cause can make you want to pick up the habit again, just to be rid of them. 

7 stop smoking aids that work

Fortunately, there are different options that help you gradually wean off of nicotine and reduce the withdrawal symptoms that make it so hard to quit. 

  1. Nicotine gum
  2. Nicotine lozenge
  3. Nicotine patch
  4. Nicotine inhaler
  5. Nicotine nasal spray
  6. Non-nicotine tablets (Chantix, Zyban)
  7. Off-label medications

Pharmacotherapy for smoking cessation falls into two main categories: nicotine replacement therapy and non-nicotine smoking cessation products.

Nicotine replacement therapy (NRT)

Nicotine replacement products provide consistent levels of nicotine that gradually decrease over time. 

NRTs are available in different formulations and strengths—over-the-counter (OTC) and prescription. They are indicated by the U.S. Food and Drug Administration to be used for 8-12 weeks but can be used longer if you and your healthcare provider feel that is necessary. 

OTC NRTs

The OTC products are all available from various name brands and are available as generics. They include:

  • Gum is chewed slowly until it tingles. Then place the gum between the cheek and gum until the tingle is gone. Repeat this process until most of the tingle is gone (approximately 30 minutes). Nicorette is a common brand name.
  • Lozenges should be allowed to dissolve slowly (approximately 20-30 minutes) and should not be chewed or swallowed. Nicorette is a common brand name.
  • Patches are applied to a clean, dry area of your skin on the upper body or upper outer arm. Patches may be worn for 16-24 hours and every patch should be applied to a different site to avoid skin irritation. Nicoderm Cq is a common brand name.

Prescription NRTs

The prescription formulations of NRT are only available under the brand name Nicotrol and are available as: 

  • Inhaler formulation is breathed in by mouth multiple times a day. It may cause irritation of the mouth or throat when first using the inhaler. Nicotrol is a common brand name.
  • Nasal spray is sprayed in the nose multiple times a day. It may cause irritation in the nose or throat when you begin using it.

Before beginning any NRT product, you should always consult your healthcare provider, especially: 

  • Women who are pregnant or breastfeeding
  • People with diabetes, asthma, or a heart condition
  • People with high blood pressure or irregular heartbeat

You should stop taking an NRT product and call your healthcare provider if you have any of the following symptoms: nausea, dizziness, vomiting, or irregular heartbeat.

Non-nicotine smoking cessation products

If you can’t use an NRT product because of a health condition, or you know you won’t remember to use it multiple times a day, there are two prescription smoking cessation drugs available in tablet form:

  • Chantix (varenicline tartrate) 
  • Zyban (bupropion hydrochloride)

Zyban is available in generic form, but Chantix is only available as a brand. 

Both of these stop smoking aids affect chemicals in your brain to help reduce your nicotine cravings and are taken twice a day. The duration of therapy for these medications is generally 12 weeks, but if you’ve successfully quit smoking, it can be used longer to reduce the risk of smoking relapse. 

Off-label medications to quit smoking

For smokers who are not successful with one of these treatments, some physicians will prescribe other medications off-label to help. Off-label just means they are not approved by the FDA for this particular use. According to the American Cancer Society, these options include nortriptyline (antidepressant), clonidine (antihypertensive), cytisine (plant compound), and naltrexone (opiate antagonist).

Side effects of smoking cessation drugs

The FDA has issued some cautions for taking these smoking cessation medications but has determined that the benefits of quitting smoking outweigh the risk of taking these medications. The risks are related to mental health adverse effects and if you notice any changes in mood or behavior while taking these medications, it should be reported to your doctor and stop taking the medication. 

Some common side effects of Chantix include nausea, sleep problems, constipation, gas, vomiting. 

For Zyban, common side effects include dry mouth, insomnia, dizziness, constipation, nausea. 

If you are considering medication to stop smoking, speak with your healthcare provider or pharmacist.

RELATED: Should you take Wellbutrin to stop smoking?

Compare smoking cessation drugs

Drug name Form Rx / OTC Side effects Popularity* Average price SingleCare coupon
Nicorette Nicotine gum OTC Mood swings, drowsiness, difficulty concentrating, increased appetite, aches and pains, constipation #1 $26.78 Get coupon
Chantix Non-nicotine tablet Rx Nausea, sleep problems, constipation, gas, vomiting #2 $487.35 Get coupon
Nicorette Nicotine lozenge OTC Mood changes, fatigue, trouble concentrating, weight gain, aches or pains, constipation #3 $23.69 Get coupon
Nicotrol NS Nicotine nasal spray Rx Nose or throat irritation #4 $473.40 Get coupon
Nicotrol Nicotine inhaler Rx Mouth or throat irritation #5 $450.54 Get coupon
Nicoderm Cq Nicotine patch OTC Application site irritation, dizziness, headache, stomach upset #6 $88.94 Get coupon
Zyban Non-nicotine tablet Rx Dry mouth, insomnia, dizziness, constipation, nausea #7 $272.34 Get coupon

* Drug popularity is based on SingleCare prescription fill data. The most popular smoking cessation drug (#1) has the most prescription fills out of the seven drugs outlined above between January 1, 2019 and May 30, 2020.

RELATED: Wellbutrin vs. Chantix

Frequently asked questions

What does smoking cessation mean?

Smoking cessation is a process to quit the use of tobacco. Tobacco contains a chemical called nicotine. Nicotine is addictive and causes withdrawal symptoms (cravings, nausea, irritability, mood swings, weight gain, etc.), which makes smoking cessation a difficult process.

What are smoking cessation products?

There are two categories of smoking cessation products:

  1. Nicotine replacement therapy: Gum, lozenges, patches, nasal sprays, and inhalers that contain a lower dose of nicotine compared to smoking and reduces withdrawal symptoms.
  2. Non-nicotine smoking cessation drugs: Oral prescription medications that do not contain nicotine but reduce withdrawal symptoms, such as cravings.

What is the most effective stop smoking aid?

There isn’t a universally effective stop smoking aid. A healthcare professional can help you find the best stop smoking aid for you.

Nicotine replacement therapy methods are equally effective and increase smoking cessation rates by 150% to 200%. Chantix claims to help more people quit smoking than the nicotine patch, bupropion, or placebo, but one clinical trial revealed no statistical significance between the products. However, another study found that Chantix was more effective than Zyban.

Note: E-cigarettes are not effective stop smoking aids. Most studies show that e-cigarettes and other vaping devices do not significantly reduce cigarette use, according to the Center on Addiction.

What tablets can you take to stop smoking?

Chantix and Zyban are two types of tablets you can take to stop smoking. However, there are other off-label medications in capsule or tablet form that a doctor may prescribe depending on your situation. These include clonidine (tablet), nortriptyline (capsule), and naltrexone (tablet).

Is smoking cessation free?

Smoking cessation could be free with insurance. Almost all health insurance plans (Marketplace, Medicaid, and Medicare Part D) cover smoking cessation therapies.

If you don’t have health insurance, you can still save on smoking cessation drugs with manufacturer coupons and prescription discount cards, like SingleCare.

RELATED: How to get free Chantix (even without insurance)

How can I quit smoking without medication?

You can successfully quit smoking without medication. Group therapy and quitting “cold turkey” are non-pharmacological approaches to smoking cessation. Those who take part in group-based smoking cessation programs are 50% to 130% more likely to quit smoking. Additionally, quitting “cold turkey” and abstaining from nicotine altogether could be the healthiest approach to quit smoking. However, withdrawal symptoms from this method are likely to be more severe than a gradual program with nicotine replacement therapies.