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Nicotine Addiction Medication

  • Author: R Gregory Lande, DO, FACN; Chief Editor: Glen L Xiong, MD  more...
Updated: Jul 15, 2016

Medication Summary

Two types of pharmacologic therapy are available as part of a smoking cessation program nicotine and antidepressants. The goals of pharmacotherapy are to induce smoking cessation, reduce morbidity, and prevent complications.


Smoking Cessation Aids

Class Summary

Nicotine replacement therapy (NRT) is available in the form of cutaneous patches, inhaled or nasal delivery, or chewing gum. Nicotine patches are sold under various trade names (see below). For each proprietary system, the dosing schedule involves a graduated decrease of the drug dose over 9-12 weeks.

Nicotine acetylcholine receptor partial agonists are also used as smoking cessation aids. They bind to nicotine receptors and elicit mild central effects to ease nicotine withdrawal symptoms. They also decrease the stimulatory effect of nicotine consumption by blocking nicotine receptors.

Nicotine transdermal system (NicoDerm CQ, Nicorette, Commit, Thrive, Nicotrol Inhaler, Nicotrol NS, Nicorelief)


Nicotine stimulates all autonomic ganglia and catecholamine discharge in the adrenal medulla at small doses. At larger doses transmission through autonomic ganglia is blocked and catecholamine discharge from the medulla is inhibited.

Nicotine replacement therapy works best when used in conjunction with a support program, such as counseling, group therapy, or behavioral therapy.

Nicotine chewing gum, if chewed correctly, increases quit rates up to 2-fold. At 1 year, the abstinence rate with the patch is 20%. At 4 years, the abstinence rate is 12.4%, as opposed to 4.5% with placebo. Nicotine patches are sold under various trade names (see below). For each proprietary system, the dosing schedule involves a graduated decrease of the drug dose over 9-12 weeks.

Nicotine gum is marketed in 2 strengths, 2 mg and 4 mg. Individuals who smoke 1 pack per day should use the 4-mg pieces; those who smoke less than 1 pack per day should use the 2-mg pieces. Instruct the patient to chew hourly and for their initial cravings for 2 weeks, then gradually reduce the amount chewed over the next 3 months.

The nicotine nasal spray and the inhaler dosage forms provide nicotine delivery through the nasal and oral mucosa, respectively.

The nicotine in nicotine polacrilex is absorbed through the oral mucosa. Absorption is quick and closely approximates the time course of plasma nicotine levels observed after cigarette smoking.

Intranasal nicotine and nicotine from an oral inhaler may closely approximate the time course of plasma nicotine levels observed after cigarette smoking.

Varenicline (Chantix)


Varenicline is a partial agonist that is selective for alpha-4, beta-2 nicotinic acetylcholine receptors. Its action is thought to result from activity at a nicotinic receptor subtype, where its binding produces agonist activity while simultaneously preventing nicotine binding. Its agonistic activity is significantly lower than that of nicotine. It also elicits moderate affinity for serotonin receptors. Maximum plasma concentrations occur within 3-4 hours after oral administration. With regular dosing, a steady state is reached within 4 days.


Antidepressants, Other

Class Summary

These medications ameliorate withdrawal symptoms while the smoker deals with behavioral aspects of smoking cessation.

Bupropion is used as a non–nicotine-containing aid to smoking cessation. It acts by enhancing central nervous nonadrenergic function. A 23% sustained cessation rate is achieved with bupropion tablets at 1 year, compared with a 12% sustained cessation rate with placebo. Bupropion also is effective for patients in whom nicotine replacement therapy fails.

Bupropion hydrochloride (Zyban)


Bupropion is used in conjunction with a support group, behavioral counseling, or both. It inhibits neuronal dopamine reuptake, in addition to being a weak blocker of serotonin and norepinephrine reuptake.

Contributor Information and Disclosures

R Gregory Lande, DO, FACN Clinical Consultant, Army Substance Abuse Program, Department of Psychiatry, Walter Reed Army Medical Center

R Gregory Lande, DO, FACN is a member of the following medical societies: American Osteopathic Academy of Addiction Medicine, American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Glen L Xiong, MD Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, Department of Internal Medicine, University of California, Davis, School of Medicine; Medical Director, Sacramento County Mental Health Treatment Center

Glen L Xiong, MD is a member of the following medical societies: AMDA - The Society for Post-Acute and Long-Term Care Medicine, American College of Physicians, American Psychiatric Association, Central California Psychiatric Society

Disclosure: Received royalty from Lippincott Williams & Wilkins for book editor; Received grant/research funds from National Alliance for Research in Schizophrenia and Depression for independent contractor; Received consulting fee from Blue Cross Blue Shield Association for consulting. for: Received book royalty from American Psychiatric Publishing Inc.


Morley Lertzman, MD, FRCP(C) Professor, Department of Medicine, Section of Pulmonary Medicine, St Boniface Hospital, University of Manitoba, Canada

Disclosure: Nothing to disclose.

Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital

Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association

Disclosure: Nothing to disclose.

  1. Centers for Disease Control and Prevention. Cigarette Smoking in the United States. Available at Accessed: ‎February ‎06, ‎2014.

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th ed. Arlington, VA: American Psychiatric Association; 2013. 571-4.

  3. Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2008 Jan 23. CD000146. [Medline].

  4. Fiore MC. Treating tobacco use and dependence: an introduction to the US Public Health Service Clinical Practice Guideline. Respir Care. 2000 Oct. 45(10):1196-9. [Medline].

  5. Esson L, Leeder SR. The millennium development goals and tobacco control: an opportunity for global partnership. Geneva: World Health Organization (WHO); 2004.

  6. World Health Organization. Why is tobacco a public health priority? A Tobacco Free Initiative; 2005. Available at Accessed: March 30, 2006.

  7. [Guideline] Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al. Guidelines for the Primary Prevention of Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2010 Dec 6. [Medline].

  8. Glassman AH, Koob GF. Neuropharmacology. Psychoactive smoke. Nature. 1996 Feb 22. 379(6567):677-8. [Medline].

  9. Picciotto MR, Brunzell DH, Caldarone BJ. Effect of nicotine and nicotinic receptors on anxiety and depression. Neuroreport. 2002 Jul 2. 13(9):1097-106. [Medline].

  10. Weinberger AH, Pilver CE, Desai RA, Mazure CM, McKee SA. The relationship of major depressive disorder and gender to changes in smoking for current and former smokers: Longitudinal evaluation in the U.S. population. Addiction. 2012 Mar 19. [Medline].

  11. Lande RG, Gragnani C. Nonpharmacologic approaches to the management of insomnia. J Am Osteopath Assoc. 2010 Dec. 110(12):695-701. [Medline].

  12. Jaehne A, Loessl B, Bárkai Z, Riemann D, Hornyak M. Effects of nicotine on sleep during consumption, withdrawal and replacement therapy. Sleep Med Rev. 2009 Oct. 13(5):363-77. [Medline].

  13. Fu SS, McFall M, Saxon AJ, Beckham JC, Carmody TP, Baker DG, et al. Post-traumatic stress disorder and smoking: a systematic review. Nicotine Tob Res. 2007 Nov. 9(11):1071-84. [Medline].

  14. Bray RM, Pemberton MR, Lane ME, Hourani LL, Mattiko MJ, Babeu LA. Substance use and mental health trends among U.S. military active duty personnel: key findings from the 2008 DoD Health Behavior Survey. Mil Med. 2010 Jun. 175(6):390-9. [Medline].

  15. Hermes ED, Wells TS, Smith B, Boyko EJ, Gackstetter GG, Miller SC, et al. Smokeless tobacco use related to military deployment, cigarettes and mental health symptoms in a large, prospective cohort study among US service members. Addiction. 2012 May. 107(5):983-94. [Medline].

  16. Cook J, Jakupcak M, Rosenheck R, Fontana A, McFall M. Influence of PTSD symptom clusters on smoking status among help-seeking Iraq and Afghanistan veterans. Nicotine Tob Res. 2009 Oct. 11(10):1189-95. [Medline]. [Full Text].

  17. Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. US Department of Health and Human Services. Available at 2013; Accessed: July 15, 2016.

  18. Peters J, Bromberg U, Schneider S, Brassen S, Menz M, Banaschewski T, et al. Lower ventral striatal activation during reward anticipation in adolescent smokers. Am J Psychiatry. 2011 May. 168(5):540-9.

  19. Bandiera FC, Richardson AK, Lee DJ, He JP, Merikangas KR. Secondhand Smoke Exposure and Mental Health Among Children and Adolescents. Arch Pediatr Adolesc Med. 2011. 165(4):332-338.

  20. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012. 2012. Available at

  21. Harrison L. E-Cigarette-Related Poison Center Calls Surge. Medscape Medical News. Available at Accessed: April 9, 2014.

  22. Farley AC, Hajek P, Lycett D, Aveyard P. Interventions for preventing weight gain after smoking cessation. Cochrane Database Syst Rev. 2012 Jan 18. 1:CD006219. [Medline].

  23. Dale LC, Schroeder DR, Wolter TD. Weight change after smoking cessation using variable doses of transdermal nicotine replacement. J Gen Intern Med. 1998 Jan. 13(1):9-15. [Medline].

  24. Thomas RE, Baker P, Lorenzetti D. Family-based programmes for preventing smoking by children and adolescents. Cochrane Database Syst Rev. 2007 Jan 24. CD004493. [Medline].

  25. Thomas R, Perera R. School-based programmes for preventing smoking. Cochrane Database Syst Rev. 2006 Jul 19. 3:CD001293. [Medline].

  26. Sowden AJ, Arblaster L. Mass media interventions for preventing smoking in young people. Cochrane Database Syst Rev. 2000. CD001006. [Medline].

  27. Cahill K, Moher M, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database Syst Rev. 2008 Oct 8. CD003440. [Medline].

  28. Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane Database Syst Rev. 2005 Jul 20. CD001118. [Medline].

  29. Henningfield JE, Fant RV, Buchhalter AR. Pharmacotherapy for nicotine dependence. CA Cancer J Clin. 2005 Sep-Oct. 55(5):281-99; quiz 322-3, 325. [Medline].

  30. Ebbert J, Montori VM, Erwin PJ, Stead LF. Interventions for smokeless tobacco use cessation. Cochrane Database Syst Rev. 2011 Feb 16;2:CD004306.

  31. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009 Apr 21. 150(8):551-5. [Medline]. [Full Text].

  32. Richmond RL, Kehoe L, de Almeida Neto AC. Three year continuous abstinence in a smoking cessation study using the nicotine transdermal patch. Heart. 1997 Dec. 78(6):617-8. [Medline].

  33. Mahmarian JJ, Moye LA, Nasser GA, et al. Nicotine patch therapy in smoking cessation reduces the extent of exercise-induced myocardial ischemia. J Am Coll Cardiol. 1997 Jul. 30(1):125-30. [Medline].

  34. Ferguson SG, Gitchell JG, Shiffman S. Continuing to wear nicotine patches after smoking lapses promotes recovery of abstinence. Addiction. 2012 Jan 26. [Medline].

  35. Stotts RC, Roberson PK, Hanna EY. A randomised clinical trial of nicotine patches for treatment of spit tobacco addiction among adolescents. Tob Control. 2003 Dec. 12 Suppl 4:IV11-5. [Medline].

  36. Murray RP, Bailey WC, Daniels K, et al. Safety of nicotine polacrilex gum used by 3,094 participants in the Lung Health Study. Lung Health Study Research Group. Chest. 1996 Feb. 109(2):438-45. [Medline].

  37. Etter JF, Huguelet P, Perneger TV, Cornuz J. Nicotine gum treatment before smoking cessation: a randomized trial. Arch Intern Med. 2009 Jun 8. 169(11):1028-34. [Medline]. [Full Text].

  38. [Guideline] U.S. Department of Health and Human Services. Public Health Service. Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008. [Full Text].

  39. Piper ME, Smith SS, Schlam TR, Fiore MC, Jorenby DE, Fraser D, et al. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Arch Gen Psychiatry. 2009 Nov. 66(11):1253-62. [Medline].

  40. Zhang B, Cohen JE, Bondy SJ, Selby P. Duration of nicotine replacement therapy use and smoking cessation: a population-based longitudinal study. Am J Epidemiol. 2015 Apr 1. 181(7):513-20. [Medline]. [Full Text].

  41. Hughes JR, Stead LF, Lancaster T. Anxiolytics and antidepressants for smoking cessation. Cochrane Database Syst Rev. 2000. CD000031. [Medline].

  42. Hurt RD, Sachs DP, Glover ED, et al. A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med. 1997 Oct 23. 337(17):1195-202. [Medline].

  43. Planer D, Lev I, Elitzur Y, et al. Bupropion for smoking cessation in patients with acute coronary syndrome. Arch Intern Med. 2011 Jun 27. 171(12):1055-60. [Medline].

  44. Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2007 Jan 24. CD006103. [Medline].

  45. Singh S, Loke YK, Spangler JG, Furberg CD. Risk of serious adverse cardiovascular events associated with varenicline: a systematic review and meta-analysis. CMAJ. Available at Accessed: July 5, 2011.

  46. US Food and Drug Administration (FDA). Chantix (varenicline): Safety Communication – Updated safety review on the risk of cardiovascular adverse events. FDA MedWatch December 12, 2012. Available at

  47. Kornitzer M, Boutsen M, Dramaix M. Combined use of nicotine patch and gum in smoking cessation: a placebo-controlled clinical trial. Prev Med. 1995 Jan. 24(1):41-7. [Medline].

  48. Hughes JR, Goldstein MG, Hurt RD, Shiffman S. Recent advances in the pharmacotherapy of smoking. JAMA. 1999 Jan 6. 281(1):72-6. [Medline].

  49. Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med. 1999 Mar 4. 340(9):685-91. [Medline].

  50. Bergen AW, Caporaso N. Cigarette smoking. J Natl Cancer Inst. 1999 Aug 18. 91(16):1365-75. [Medline].

  51. Nabi Biopharmaceuticals. Nabi Biopharmaceuticals Announces Results of First NicVAX(R) Phase III Clinical Trial. Nabi Biopharmaceuticals. Available at Accessed: July 18, 2011.

  52. Lancaster T, Stead LF. Mecamylamine (a nicotine antagonist) for smoking cessation. Cochrane Database Syst Rev. 2000. CD001009. [Medline].

  53. Grimshaw GM, Stanton A. Tobacco cessation interventions for young people. Cochrane Database Syst Rev. 2006 Oct 18. CD003289. [Medline].

  54. Brooks M. Drug Combo Boosts Early Quit Rates in Smokers. Available at Accessed: February 1, 2014.

  55. Chatham-Stephens K, Law R, Taylor E, Melstrom P, Bunnell R, Wang B, et al. Notes from the field: calls to poison centers for exposures to electronic cigarettes - United States, september 2010-february 2014. MMWR Morb Mortal Wkly Rep. 2014 Apr 4. 63(13):292-3. [Medline].

  56. Ebbert JO, Hatsukami DK, Croghan IT, Schroeder DR, Allen SS, Hays JT, et al. Combination varenicline and bupropion SR for tobacco-dependence treatment in cigarette smokers: a randomized trial. JAMA. 2014 Jan 8. 311(2):155-63. [Medline].

  57. Reuters Staff. No Change in Tobacco Use Among U.S. Youth; E-Cigarettes Preferred. Medscape Medical News. Available at April 15, 2016; Accessed: April 20, 2016.

Smoking cessation strategies for clinicians.
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