An Overview of Tobacco Cessation Medications
Medications are important and effective tools for increasing cessation success by relieving nicotine craving and
withdrawal symptoms. Medical providers should encourage all tobacco users who are planning a quit attempt to use
one or a combination of cessation medications, except when medically contraindicated. There are currently seven
FDA-approved tobacco cessation medications available that increase long-term tobacco use quit rates. These treatments
are listed in the chart below and are available either by prescription or over-the-counter (OTC).1
Start 1–2 weeks before 150 mg tablet twice
the quit date; use 3–6 patient has stopped
hours; not to exceed 24 4 mg, 100–110 pieces = $63
day in first 6 weeks; not $34; 4 mg, 72 lozenges per box
a Cost data excerpted from Treating tobacco use and dependence: 2008 update. Cost was estimated by averaging the retail price of medications at
national chain pharmacies in several U.S. cities and online price listings in January 2008. For nicotine replacement therapy products, the quantity used will determine how long the supply lasts and will vary by individual. Combination Medications
A number of combinations of medications are also effective in improving quitting success, and using two types of
tobacco cessation medications simultaneously can improve quit rates when compared with one medication.4, 5, 6, 7
Combination therapy or high-dose nicotine replacement therapy (NRT) may be suitable for those who are highly
nicotine dependent or have a history of severe withdrawal symptoms.1, 9 The following combination therapies are
effective in increasing quit rates.1, 2, 9, 10
• Long-term nicotine patch + other NRT product (gum or spray)• Nicotine patch + nicotine inhaler• Nicotine patch + Bupropion SR
It is important to provide plan participants with a wide range of treatment options, as success with particular methods
varies among individuals. Smokers who are ready to quit should talk with their doctors to learn about possible
treatment approaches so they can select the options most appropriate for them. Because the process of quitting usually
involves several attempts, smokers may need to try several different types of cessation medications before achieving
success. The combination of medications and counseling is more effective than the use of either method alone.1
Fiore MC, Jaén CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville,
MD: U.S. Department of Health and Human Services. Public Health Service; 2008. Available at:
Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev.
Hughes JR, Stead LF & Lancaster T. Antidepresssant for smoking cessation. Cochrane Database Syst Rev. 2007;1:CD000031.
Fagerstrom KO. Combined use of nicotine replacement therapies. Health Values. 1994;18:15-20.
Kornitzer M, Boutsen M, Dramaix M, Thijs J, Gustavsson G. Combined use of nicotine patch and gum in smoking
cessation: a placebo-controlled clinical trial. Prev Med. 1995;24:41-47.
Puska P, Korhonen H, Vartiainen E, Urjanheimo EL, Gustavsson G, Westin A. Combined use of nicotine patch and gum
compared with gum alone in smoking cessation: A clinical trial in North Karelia. Tob Control. 1995;4: 231-235.
Blondal T, Gudmundsson LJ, Olafsdottir I, Gustavsson G, Westin A. Nicotine nasal spray with nicotine patch for smoking
cessation: randomised trial with six year follow-up. BMJ. 1999;318:285-288.
Corelli RL, Hudmon KS. Medications for smoking cessation. West J Med. 2002;176(2):131–135.
Ebbert JO et al. Varenicline and bupropion sustained-release combination therapy for smoking cessation. Nicotine Tob Res.
10 Sherman SE, Aldana I, Estrada M, York L. Comparing the tolerability and effectiveness of two treatment regimens in a
smoking clinic. Mil Med. 2008;173(6):550-554. To learn more about smoking cessation,
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