Quit Smoking Treatment

There are a range of treatments and techniques available to help you quit smoking, such as prescription medication and nicotine replacement therapy (NRT).

Prescription medication

There are currently 3 prescription medications available to quit smoking: Zyban, varenicline (Champix), and Cytisine.

Zyban – Zyban contains the active ingredient bupropion hydrochloride, which is also an antidepressant. Zyban affects the parts of your brain responsible for cravings and addiction, making it easier to manage cravings and withdrawal symptoms when you quit. It also makes smoking less enjoyable if you smoke during treatment. It works best after taking it for a few days.

Zyban is taken over 7 to 9 weeks, after which you should stop taking it. The usual dosage is 1 or 2 tablets daily.

Varenicline – Varenicline is a generic medication containing varenicline. It is also found under the brand name Champix, another prescription stop smoking medication that contains the same active ingredient. Varenicline can reduce cravings and the severity of withdrawal symptoms by binding to the same receptors that nicotine does. This stops nicotine from binding to them and stimulates a small amount of dopamine instead.

Varenicline is taken every day, starting with a once per day dose of 0.5mg and slowly increasing to 1mg, twice a day. You’ll take it for 12 weeks, although your doctor can extend this for another 12 weeks if you still need support with quitting. You should plan to stop smoking between days 7 to 14 of treatment.

Cytisine – Cytisine is a new stop smoking medication. Each Cytisine tablet contains 1.5mg of the active ingredient cytisine. It works in a similar way to Champix, reducing the urges you get to smoke by attaching itself to some of the same receptors in your brain that nicotine does (the drug in tobacco that makes it addictive). This makes it easier to quit, especially at the start. It works within a couple of hours.

Nicotine replacement therapy (NRT)

NRT products contain nicotine without the added harmful chemicals of a cigarette. They can reduce withdrawal symptoms by providing your body with nicotine.

NRT comes in 2 forms; it’ll either work immediately (fast-acting) or within a few hours (slow-release). It’s best to combine both types to improve your chances of quitting.

As NRT contains nicotine, it can also be addictive. It's important to stop using NRT gradually.

You may not be able to use NRT alongside certain stop smoking prescription medications, especially if you have other health conditions. Speak to your doctor if you want to use NRT and are taking medication.

There are many benefits to quitting smoking, such as:

• easier breathing and reductions in breathing problems
• improved lung health
• younger and brighter looking skin, as more oxygen can get to your skin and you’re no longer inhaling harmful chemicals
• improved dental health
• less staining on the teeth from tar
• less smoking-related disease risk
• more energy
• improved fertility (if you’re trying for a baby, your doctor may recommend quitting)
• a stronger immune system
• decreased stress and anxiety levels, as nicotine can increase both of these in the long-term, even if it provides short-term relief
• improved sense of taste and smell
• better blood circulation, which can improve heart and muscle health and make it easier to do physical activity
• a smaller risk of developing a range of health conditions, such as bone disease, eye disease, dementia, and type-2 diabetes
• protecting others from secondhand smoke

When you quit smoking, you’ll get withdrawal symptoms and crave cigarettes. These are strongest in the first few weeks and can last a few months, but will gradually get easier to manage. Withdrawal symptoms and cravings can be managed with prescription medications, NRT, and other techniques.

Common withdrawal symptoms when you quit smoking include:

• a change in mood, including irritability, anger, sadness, and anxiety
• feeling jumpy and restless
• difficulty concentrating
• difficulty falling and staying asleep
• feeling hungrier, which can lead to weight gain
• headaches
• nausea (feeling sick)
• feeling generally unwell

There are 2 different types of cravings you can get after you quit smoking, which are:

• A craving for a cigarette that doesn’t go away – this tends to get better within a few weeks to a few months.
• A sudden and immediate need for a cigarette – this is usually triggered by something, such as a social event where everyone goes outside to smoke, or due to strong emotions, such as stress. You’ll start to notice that certain people, smells, sounds, or places can trigger an immediate craving, so it’s best to avoid these where you can, although this isn’t always possible.

How can I manage withdrawal symptoms?

You can manage your withdrawal symptoms and cravings in several ways, such as:

• starting quit smoking treatment
• getting advice and support from a stop smoking clinician
• speaking to family and friends
• removing the temptation to smoke by getting rid of any cigarettes in the house
• using techniques to distract or calm your mind, such as deep breathing
• using something that can keep your hands busy when you’re craving a cigarette, such as fidget toy
• reminding yourself why you’re quitting

Managing different withdrawal symptoms

If you’re feeling irritable or anxious, try doing something that makes you happy or helps you to relieve stress, such as exercising or doing something you enjoy.

If you’re feeling jumpy or restless, reduce your caffeine intake, especially before you go to sleep. When you stop smoking it can impact how your body responds to caffeine, so it could feel stronger or the effects can last longer than they did before. This is because nicotine changes your body's ability to absorb and utilise caffeine.

If you’re feeling hungrier than usual, try to snack on low-calorie, healthy options or use something to keep your mouth busy, such as chewing gum.

If you have trouble falling asleep, don’t use a 24-hour nicotine patch. You can also look at ways to improve your sleep habits, such as not using screens before bed or making the room darker and more comfortable for sleep.

How long will withdrawal symptoms last?

Withdrawal symptoms are strongest in the first few weeks. As the weeks go by, your withdrawal symptoms should lessen until they eventually go away altogether, although this can take several months.

When will I stop craving cigarettes?

This is different for everyone, but most people have fewer cravings once withdrawal symptoms start to get better. You may never fully stop craving cigarettes, but it’s most likely to happen every now and then, rather than all the time. For example it may happen when you are going out with a friend who smokes, even if months have passed since you thought about cigarettes.

Some people stop craving cigarettes altogether after they’ve stopped smoking for several months or more. You may find that you no longer enjoy the smell or taste, or that they make you feel nauseous.

Yes, like all medications, prescription stop smoking medication can cause some side effects. This isn’t likely to be long-term, as you only take prescription stop smoking medication for a few weeks or a few months, depending on the treatment. Side effects are most likely at the start of your treatment, but it may be difficult to tell whether this is a side effect of the medication or a withdrawal symptom.

If your side effects don’t go away or get better within a few weeks of taking your treatment, speak to your doctor or stop smoking advisor. If you get serious or severe side effects (including chest pain, shortness of breath, severe stomach pain, persistent changes to your heart rate or blood pressure or very low mood), call 112 or 999 in an emergency.

Zyban side effects

Most common side effects of Zyban include:

• difficulty falling asleep – it’s best to avoid taking your treatment near bedtime
• feeling depressed, anxious, or agitated
• difficulty concentrating
• feeling shaky
• headache
• nausea
• vomiting (being sick)
• stomach pain
• constipation
• changes in taste
• dry mouth
• fever
• dizziness
• sweating
• skin rash
• itching

For a full list of all Zyban side effects, please read the patient information leaflet.

Varenicline (Champix) side effects

Most common side effects of varenicline (Champix) include:

• inflammation of the nose and throat
• strange dreams
• difficulty sleeping
• headache
• nausea
• chest infection or sinus inflammation
• weight changes (increase or decrease)
• appetite changes
• shortness of breath
• coughing
• heartburn
• vomiting
• constipation
• diarrhoea
• bloating
• stomach ache
• tooth ache
• indigestion
• flatulence (gassiness)
• dry mouth
• skin rash and/or itching
• aching joints
• aching muscles
• back pain
• chest pain
• tiredness

Please see the Varenicline patient information leaflet for more information on side effects.

Cytisine side effects

Most common side effects of Cytisine include:

• change in appetite (mainly an increase)
• weight gain
• dizziness
• irritability
• mood changes
• anxiety
• high blood pressure
• dry mouth
• diarrhoea
• rash
• fatigue
• sleep disorders (insomnia, drowsiness, lethargy, abnormal dreams, nightmares)
• headaches
• increased pulse
• nausea
• changes in taste
• heartburn
• constipation
• vomiting
• abdominal pain (especially the upper abdomen)
• muscle pain

For a full list of all Cytisine side effects, please read the patient information leaflet.

Safety information and warnings

You should not use any prescription stop smoking medication without the help of a doctor or stop smoking advisor. They will check your medical history and current medications to make sure it’s safe and suitable for you to take. You should also speak to a doctor before using NRT.

You should not use stop smoking treatment if you:

• have an allergy to any of the ingredients
• are under 18, unless your doctor has told you otherwise
• do not smoke
• are pregnant or breastfeeding

Zyban may not be suitable if you:

• have a mental health condition, such as anxiety, depression, bipolar disorder, or an eating disorder
• have epilepsy
• have uncontrolled high blood pressure

Please see the Zyban information leaflet for a full list of health conditions and medications where it would be unsuitable.

Varenicline or Champix may not be suitable if you:

• have epilepsy
• have a mental health condition
• have significant kidney dysfunction

Please see the Champix information leaflet for a full list of health conditions and medications for which it would not be suitable.

Cytisine is also not suitable if you:

• have unstable angina
• have recently had a heart attack or stroke
• have clinically significant arrhythmias (an irregular or abnormal heart rhythm)
• take certain anti-TB medications
• have significant kidney or liver dysfunction

Please see the Cytisine information leaflet for a full list of health conditions and medications for which it would not be suitable.

If you use oral contraception, such as the combined contraceptive pill, you should use a secondary barrier method whilst taking Cytisine because its impact on the effectiveness of the pill is not yet known.

Can I use NRT while pregnant or breastfeeding?

NRT is safe for most people, but check with your doctor first, especially if you are:

• under 18
• pregnant – you may be able to use NRT if your doctor thinks it’ll help you quit
• breastfeeding – your doctor or midwife will explain how to take this safely