Medication
Cessation Through Medication
- Overcoming nicotine addiction often requires repeated provider interventions and multiple patient attempts.
- The use of FDA-approved medications helps reduce withdrawal symptoms and increases your patients’ smoking cessation success.
- Evidence shows combining long-acting together with short-acting nicotine replacement therapy (NRT) can more than triple long-term quit rates.
- MO HealthNet (Missouri’s Medicaid Program) covers evidence-based smoking cessation treatment, including all seven FDA-approved medications when prescribed. Private health insurance and Medicare plans vary.
The U.S. Food and Drug Administration (FDA) has approved seven medications that can help your patients quit for good:
| Brand Name | Generic Name |
|---|---|
| Nicorette | Nicotine Gum* |
| Nicotrol Inhaler | Nicotine Inhaler ℞ |
| Nicorette Lozenge | Nicotine Lozenge* |
| Nicotrol NS | Nicotine Nasal Spray ℞ |
| Nicoderm | Nicotine Patch* |
| Chantix | Varenicline ℞ |
| Zyban/Wellbutrin | Bupropion SR ℞ |
* available over-the-counter (OTC) and covered by MO HealthNet (Medicaid) and some health insurance plans with prescription
℞ requires prescription
Combination Pharmacotherapy
Not all smokers can quit with single-drug therapy. Evidence exists that combination pharmacotherapy increases long-term abstinence rates relative to placebo treatments. Note: Varenicline should not be combined with any other smoking cessation medication.
- Combination long-acting used with short-acting NRT
- Provides a stable baseline nicotine level from the sustained release transdermal patch with immediate release nicotine gum, lozenge, nasal spray or oral inhaler;
- May provide a therapeutic advantage by increasing nicotine concentrations to help prevent the onset of severe withdrawal symptoms;
- May be particularly effective in suppressing tobacco withdrawal symptoms and especially useful for highly dependent smokers or those with a history of severe withdrawal.
- Bupropion used with long-acting transdermal patch
- Monitored treatment with bupropion and an NRT patch is more effective in increasing long-term cessation abstinence than either medication alone.
FDA changes make it easier to prescribe safe and effective smoking cessation regimens for your patients:
- Determined there are no significant safety concerns with prescribing combination nicotine replacement therapy (NRT) or using NRT even if a person is still smoking;
- Determined it is safe in most cases to use NRT longer than the 8 to 12 weeks that label directions may state; and
- Evaluated varenicline and bupropion and found the benefits outweigh the risks of using them for most people. As a result, FDA approved the removal of the boxed warning about potential neuropsychiatric side effects from the drug labels of both Chantix and Zyban when used for smoking cessation.
Informational PDFs
Prescription Chart for FDA-Approved Smoking Cessation Medications – information on nicotine replacement therapies, precautions and dosing.
Mayo Clinic Tobacco Dependence Treatment Medication Summary – information on nicotine replacement therapies, pros and cons, dosing, comments and limitations, combination therapies and NRTs for smokeless tobacco treatment.
Smoking Cessation Medication Prescription Chart, Instructions and FAQs – New York’s Talk to Your Patient Campaign medication chart
Additional Information
FDA Drug Safety Communication: FDA revises description of mental health side effects of the stop-smoking medicines Chantix (varenicline) and Zyban (bupropion) to reflect clinical trial findings (December 2016) – U.S. Food and Drug Administration
Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions (December 2015) - U.S. Preventive Services Task Force
Modifications To Labeling of Nicotine Replacement Therapy Products for Over-the-Counter Human Use (April 2, 2013) – U.S. Food and Drug Administration