Respiratory
Smoking-cessation aids
NRT, varenicline and bupropion — Medicines that roughly double the chance of quitting smoking when combined with support.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
These medicines help people stop smoking by easing cravings and withdrawal. Used alongside behavioural support, they substantially increase the chance of a successful quit.
How it works
NRT supplies nicotine without the harmful smoke, smoothing withdrawal. Varenicline acts on the brain's nicotine receptors to reduce both craving and the reward from smoking. Bupropion works through other brain pathways to lessen the urge. All aim to make the early weeks of quitting manageable.
In practice
In practice the most effective approach combines a quit medicine with behavioural support, and the choice spans nicotine replacement therapy (NRT), varenicline and bupropion. NRT is the most flexible and safest, and combining a long-acting patch with a fast-acting form (gum, lozenge, inhalator or spray) for breakthrough cravings works better than either alone. Varenicline is highly effective and is typically started while still smoking, with a quit date a week or two later. Bupropion is an alternative that lowers the seizure threshold, so it is avoided where that risk is raised. Across all options, mood should be monitored, and an important physiological point is that stopping smoking itself raises the blood levels of some drugs (such as theophylline and some antipsychotics and clozapine), which may need dose review. Quit aids are appropriate and beneficial in cardiovascular and respiratory disease, where stopping smoking is one of the highest-value interventions available.
Examples
Practical use
How to take it & use it well
- Set a quit date and use your chosen aid from that day, following the schedule your stop-smoking adviser or pharmacist gives you.
- For nicotine replacement, a common approach is to combine a long-acting patch with a faster-acting form such as gum, lozenge, spray or inhalator for cravings.
- Apply nicotine patches to clean, dry, hairless skin and rotate the site each day to reduce skin irritation.
- With varenicline or bupropion, start before your quit date as directed, since these are built up over several days before you stop.
- Use your aid for the full recommended course rather than stopping as soon as cravings ease, to lower the chance of relapse.
- Stay in touch with a stop-smoking service, as regular support clearly improves your chances of quitting for good.
Common uses
- Stopping smoking (with behavioural support)
- Reducing relapse during a quit attempt
Monitoring
- Quit progress and cravings
- Mood and any neuropsychiatric symptoms
- Doses of smoking-affected medicines after quitting
Weighing it up
Advantages & disadvantages
Advantages
- Quitting smoking is one of the most powerful things you can do for your heart, lungs and long-term health.
- These aids ease cravings and withdrawal, making it far more likely you will succeed than willpower alone.
- Several options are available, so you and your adviser can choose what suits your habits and preferences.
- Free NHS stop-smoking support combined with these medicines gives the best success rates.
Disadvantages
- Nicotine products can cause skin irritation, mouth or throat soreness, hiccups, nausea or vivid dreams depending on the form.
- Varenicline and bupropion can cause nausea, sleep disturbance, and changes in mood, so report low mood or unusual thoughts promptly.
- Bupropion can lower the seizure threshold and is not suitable for everyone, so a careful check is needed before starting.
- Stopping smoking changes how the body handles some medicines, which can raise their levels and need dose review.
Key safety principles
What to watch for
- Monitor mood and behaviour during a quit attempt.
- Bupropion lowers the seizure threshold — avoid where seizure risk is increased.
- Stopping smoking raises levels of some drugs (e.g. theophylline, some antipsychotics/clozapine) — review doses.
Key interactions
What to avoid or check alongside
- Stopping smoking can raise blood levels of some medicines such as theophylline and clozapine, so doses may need lowering after you quit.
- Bupropion can interact with several medicines, including some antidepressants and other treatments that affect seizure risk, so a full medicines check is essential.
- Bupropion should not be combined with certain older antidepressants known as monoamine oxidase inhibitors because of the risk of serious reactions.
- Smoking cessation can affect insulin requirements in diabetes, so monitor blood glucose more closely after quitting.
- Always tell your pharmacist about every medicine you take when starting a quit aid, as adjustments are sometimes needed.
Patient & carer advice
- Combining a patch with a faster-acting form helps with breakthrough cravings
- Behavioural support alongside the medicine gives the best chance
- Tell us your other medicines — some need adjusting once you stop smoking
Use with
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Answers
Smoking-cessation aids: frequently asked questions
Can I use a nicotine patch and gum together?
Yes. Combining a long-acting patch with a faster-acting form like gum, lozenge or spray is a common and effective approach. The patch gives a steady background and the short-acting form tackles sudden cravings.
Do I need to keep smoking when I start varenicline or bupropion?
These are usually started a week or two before your quit date and built up gradually, so you keep smoking at first and then stop on your planned quit day.
Why might my other medicines need adjusting when I stop smoking?
Chemicals in tobacco smoke speed up how the body clears certain drugs. When you stop, levels of medicines such as theophylline and clozapine can rise, so your team may reduce the dose.
Are mood changes a risk with stop-smoking medicines?
Some people notice changes in mood, and nicotine withdrawal itself can affect mood. Report any low mood, agitation or unusual thoughts to your adviser or prescriber straight away.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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