Quitting Tobacco: Non-nicotine Medications

Nicotine is an addictive ingredient found in tobacco products. Nicotine binds to receptors in your brain and increases the release of dopamine. Dopamine is a neurotransmitter that helps you feel pleasure. Not having nicotine can also change your mood. Some people who quit smoking become depressed. This may be because the levels of dopamine in their brain is affected by the lack of nicotine.

Nicotine remains in your body for a short period of time. Not having nicotine can cause cravings for it. This can make it hard to quit tobacco use. There are a few things that can help you quit tobacco use. These are:

• Nicotine replacement therapy (NRT).
• Non-nicotine medications.
• Non-medication interventions.

This article will focus on non-nicotine medications. Taking these medications can help you quit tobacco. They are safe and effective for most people. Talk with your healthcare provider about your plan for quitting or about any past experiences trying to quit. Together you can make a plan based on what did or did not work before.

Non-nicotine Medications

These medications do not contain nicotine and can be used with other NRTs and non-medication interventions. They are prescribed by a healthcare provider and should be taken as instructed. Check with your insurance company to see if they are covered.

Bupropion (Wellbutrin®, Zyban®)

• An antidepressant that helps to decrease your cravings for nicotine and withdrawal symptoms.
• You should start taking the medication 7-10 days before your targeted quit day.
• Possible side effects include dry mouth, trouble sleeping, feeling tired, nervousness, nightmares, and change in appetite/weight.
• If you have a history of seizures, disordered eating (bulimia, anorexia), or are taking an MAO inhibitor (for depression or Parkinson’s), you should not use this medication.
• This medication can affect your mood. If you have changes in your behavior or have thoughts about hurting yourself while using this medication, call your provider right away.

Varenicline

• This medication works by interfering with nicotine receptors. It can reduce the symptoms of nicotine withdrawal and makes it less pleasurable to use tobacco.
• May work for people who have tried NRT or bupropion but have not been able to quit.
• You must start taking this medication before your quit date. Talk with your provider about when to start and how to take this medication.
  • It is often used for 12 weeks. Your provider may have you take it longer if needed.
  • Possible side effects include nausea and vomiting, headache, trouble sleeping, dreams, sleepwalking, constipation, gas, and taste changes.
  • This medication can affect your mood and behavior. Tell your provider right away if you are experiencing anger, hostility, panic, or have thought about hurting yourself. This may happen more in people with a history of depression or other mental health issues.
  • This medication can also impact your heart health. Be sure to tell your provider if you have a history of heart disease and if you have any new chest pain or shortness of breath.

Other Medications

Nortriptyline

• An antidepressant medication that may be helpful for quitting tobacco by lessening withdrawal symptoms.
• It is not FDA-approved for this but is used “off-label”. It may be useful if you haven’t had success with NRT or other medications.

Clonidine

• A blood pressure medication that may be helpful for quitting tobacco by lessening withdrawal symptoms and cravings.
• It is not FDA-approved for this but is used “off-label”, especially for individuals who haven’t had success with NRT or other medications.

It is important to use medications with other strategies to help you quit tobacco, including quit programs, calling a quit line, or attending a quit tobacco group/therapy. You can learn more about these programs here.

Want to quit tobacco? See our article Smoking Cessation. Where do I Start? for tips to help you quit.