Common Smoking Cessation Medications and Nicotine Replacement Therapy: What Are the Side Effects?

Good news: There are now more former smokers than current smokers. If you want to quit smoking, there are various prescription and OTC medications available to help you.
 
We all know that smoking leads to significant health issues and exacerbates other medical conditions. Quitting smoking for health reasons is not easy and may require many attempts, but the potential to improve your current and future health is worth it. Here’s an encouraging message: the U.S. health department states that the number of former smokers has surpassed the number of current smokers, meaning that more than half of smokers have successfully quit. If you want to quit smoking, there are various prescription and over-the-counter (OTC) medications available to help you.

Commonly prescribed medications

Prescription medications that can help you quit smoking include Zyban (bupropion), Chantix (varenicline), Catapres (clonidine), and Nortriptyline (desipramine). If you want to try prescription medication, there are nicotine patches (Nicoderm CQ, Nicotrol), nicotine gum (Nicorette, Thrive), and nicotine lozenges (Commit, Nicorette). You can also obtain nicotine nasal sprays and nicotine inhalers (Nicorette, Nicotrol) by prescription.

How they work
 
Nicotine replacement therapy (NRT) includes patches, gum, lozenges, nasal sprays, and inhalers that contain small amounts of nicotine, aimed at gradually weaning the body off its dependence on nicotine. This gradual reduction helps to lessen the severity of withdrawal symptoms and can help you reduce cravings to smoke. You can even use patches in conjunction with another form of NRT for more effective relief from your withdrawal symptoms and cravings, but be sure to discuss this with your doctor first.

Smoking cessation prescription medications do not contain nicotine, and some can be used alongside NRT as long as your healthcare provider approves. Zyban (Wellbutrin) and Chantix (varenicline) are FDA-approved to help with smoking cessation. Although older antidepressants like Nortriptyline and Clonidine are not FDA-approved for smoking cessation, they may sometimes be used if Zyban or Chantix fail.

Chantix works by blocking nicotine from attaching to nicotine receptors in the brain, eliminating the pleasure of smoking, and activating other brain receptors to alleviate withdrawal symptoms. Zyban works by interacting with certain chemicals in the brain to reduce nicotine cravings and withdrawal symptoms. It is still unclear how Nortriptyline and Clonidine control smoking.

Side effects and how to manage them

Not every user experiences side effects, and for those who do, many side effects will diminish once your body adjusts to the medication.

The most common side effects of NRT include:

Patches: Skin redness, such as swelling, headaches, dizziness, nausea, vomiting, sleep disturbances, and diarrhea. If it irritates your skin, try using a different brand of patch.

Gum: Dizziness, vomiting, nausea, diarrhea, weakness, sore throat, oral irritation, irregular heartbeat, and jaw pain.

Lozenges: Sore throat, heartburn, headaches, hiccups, insomnia, irregular heartbeat, coughing, and nausea.

Nasal sprays: Throat irritation, sneezing, throat inflammation, runny nose, tearing, coughing, and warmth sensation.

Inhalers: Coughing, sore throat, dizziness, irregular heartbeat, nervousness, runny nose, stomach discomfort, or throat inflammation.

If you experience these side effects and they do not go away, try reducing your dosage or consider using a different type of NRT.

The most common side effects of prescription medications include:

Zyban: Drowsiness, sleep disturbances, anxiety, dizziness, dry mouth, headaches, nausea, vomiting, abdominal pain, tremors, high blood pressure, nasal congestion, loss of appetite, weight loss, constipation, sweating, sore throat, and changes in taste.

Chantix: Nausea, bloating, constipation, diarrhea, abdominal pain, rash, heartburn, vomiting, dry mouth, abnormal dreams, sleep disturbances, headaches, fatigue, seizures, mood changes, and joint or muscle pain.

Nortriptyline: Nausea, drowsiness, fatigue, anxiety, nightmares, appetite changes, rapid heartbeat, constipation, dry mouth, urinary issues, sweating, and sexual dysfunction.

Clonidine: Dry mouth, fatigue, drowsiness, headaches, sexual dysfunction, nausea, vomiting, and constipation.

User experiences

After smoking for nearly 20 years, 43-year-old Donna Riverton decided to use a generic version of the nicotine patch to quit smoking. She followed the instructions on the package, gradually reducing the nicotine strength and using them for the specified duration. Fortunately, she experienced no side effects. She said: "This treatment helped me completely quit smoking. I haven't smoked for ten and a half years. Sometimes, when I feel stressed, I think about smoking again, but when I look at my children's faces, I don't want them to develop that habit or be exposed to secondhand smoke."

Shaniqua Jones, 34, a smoker for 22 years, has tried several treatments to help her quit smoking. She was allergic to the adhesive on the nicotine patch, which caused her skin to itch and blister, so she could only use it for a day or two. She also tried Zyban for about a month but said it had no effect. "Chantix was the worst," she said. "Every time I took the medication, I wanted to vomit, had nightmares, and when I had nightmares, I felt terrible because I was always shaking and sweating while I slept." Although she used Chantix for three months, it had no effect. She plans to try again in the future, saying she will consider cinnamon gum and vaping devices.

Tim Schmidt, 40, a smoker for 23 years, tried Chantix a few years ago but said it did nothing to curb his desire to smoke. However, he admitted that many medications seem to have no effect on him. While taking Zyban, he also experienced vivid dreams and nausea.

Drug interactions

All of these treatments can interact with other medications, so it is important to talk to your healthcare provider or pharmacist if you are taking any other prescription or over-the-counter medications, including vitamins and supplements. Chantix may interfere with the effectiveness of insulin, asthma medications, and blood thinners.

Monoamine oxidase inhibitors (MAOIs) are a class of older antidepressants that should be avoided while taking Zyban, as Wellbutrin is also an antidepressant that contains bupropion.

Effectiveness and considerations

Research shows that using nicotine replacement therapy can nearly double your chances of quitting smoking. Many studies have also shown that Chantix and Zyban are very effective in helping people quit smoking, with Chantix being proven to be the most effective smoking cessation treatment in multiple trials.

Nortriptyline is moderately effective, while Clonidine has limited effects and is reported to have more side effects, so it is used less frequently.

How to choose?

While these treatments can help with the physical aspects of quitting smoking, you may also consider joining a smoking cessation class, a support group, or receiving counseling to help with the emotional and behavioral aspects. Using these adjunct therapies can increase your chances of successfully quitting smoking.

Hypnotherapy is a non-drug option, and one study found it to be more effective than NRT in helping smokers quit. Acupuncture is another alternative therapy that some people attempt to use to help break the smoking habit. A 2014 Cochrane review found that while there are indications that acupuncture may help with smoking cessation in the short term, the evidence becomes less clear after six months.

Overall, according to the U.S. National Center for Complementary and Integrative Health, the evidence for the effectiveness of smoking cessation therapies is inconsistent.