Medications for Tobacco Use Disorder

Bupropion is a prescription medication approved by the Food and Drug Administration (FDA) as both an antidepressant (marketed as different formulations of Wellbutrin) and a smoking cessation medication (Zyban). Although the exact way bupropion helps with smoking cessation is unknown, it has been shown to reduce the urge to smoke and decrease nicotine withdrawal symptoms. Typically, bupropion is started one to two weeks before a target quit date. 

Bupropion can be combined with nicotine replacement therapies (NRT) or varenicline (Chantix), another prescription medication smoking cessation. Bupropion is contraindicated for people who have a seizure disorder or a current or past diagnosis of bulimia or anorexia nervosa. Additionally, two bupropion containing medications, such as Wellbutrin and Zyban, should not be combined. Bupropion should be used with caution in people diagnosed with psychiatric disorders, especially bipolar spectrum disorders. The healthcare professional prescribing bupropion can answer questions about its use with comorbid medical and psychiatric conditions.

Nicotine replacement therapy (NRT) reduces nicotine withdrawal symptoms and cravings by providing nicotine without the harmful chemicals found in tobacco products.

By treating nicotine withdrawal symptoms and cravings, NRT can help people reduce the amount of a tobacco product they are using or help them stop using tobacco completely.

These therapies come in five different formulations:

• Patch (available over-the-counter)
• Gum (available over-the-counter)
• Lozenge (available over-the-counter)
• Inhaler (prescription only)
• Nasal spray (prescription only)

While there are no absolute contraindications to using NRT, caution should be exercised by people who recently had a heart attack or who have certain heart conditions. A healthcare professional should be consulted if there are any questions about the use of NRT. There is evidence that one of the most effective treatments for tobacco use disorder is to combine a long-acting formulation of NRT, such as the patch, with a short-acting formulation, such as the gum, lozenge, inhaler, or nasal spray, for breakthrough withdrawal symptoms. NRT also can be combined with bupropion but there is limited evidence for combining NRT with varenicline (Chantix).

Varenicline (Chantix), a partial agonist at nicotinic acetylcholine receptors, both reduces nicotine withdrawal symptoms and blocks nicotine from binding to the receptors. There is evidence that varenicline is more effective than bupropion or the nicotine patch and it is recommended as a first line treatment for tobacco cessation. Varenicline should be started one week prior to the target quit date and should be continued for 12 weeks. However, it can be prescribed for longer than 12 weeks based on the needs of the individual. While there are no absolute contraindications to taking varenicline, there have been reports of people experiencing increased intoxicating effects of alcohol while taking varenicline. It is important to note that varenicline has not been shown to increase the risk of neuropsychiatric effects such as depressed mood, suicidality, or aggression in individuals both with and without psychiatric disorders. The healthcare professional prescribing varenicline can answer questions and provide guidance about its use for tobacco use disorder.