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Medication for quitting smoking

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Varenicline (EU: Champix, U.S.: Chantix) can increase the chances of success if you are trying to quit smoking. The possible side effects include temporary sleep problems and nausea.

Bupropion (trade name: Zyban), varenicline (EU: Champix, U.S.: Chantix) and cytisine (Asmoken) are approved in Germany for quitting smoking. They are prescription-only, so they have to be prescribed by a doctor.

There are many studies on the effectiveness of varenicline. In the studies, the researchers looked at whether the participants still smoked, or had started smoking again, after 6 to 12 months.

The benefits of bupropion and cytisine are not clear because the manufacturers haven’t made all of the study data available.

There may be individual medical reasons related to why you should or shouldn’t use these medications. It is best to discuss this with your doctor. And it’s important to let your doctor know about any other medications you are taking. That helps to avoid possible interactions between the medications.

These medications may make you feel tired and affect your ability to drive because they influence chemical messengers in your brain. So it’s a good idea to wait before operating heavy machinery or driving a car to see how you react to them.

How is varenicline (EU: Champix, U.S.: Chantix) used?

Another medication that’s available for people who would like to quit smoking is called varenicline (trade name: Champix in the EU, Chantix in the U.S.). It has two effects:

  • It relieves nicotine withdrawal symptoms, and
  • it makes smoking less pleasurable.

Treatment with varenicline is also started one to two weeks before you try to quit smoking. The dose is then gradually increased. You take:

  • one 0.5 mg tablet per day on the first 3 days of treatment,
  • two 0.5 mg tablets per day on days 4 to 7 of treatment, and
  • two 1 mg tablets per day from the second week of treatment onwards. You also stop smoking during the second week of treatment.

Varenicline tablets are taken in the morning and evening with a glass of water, not necessarily with meals. The treatment lasts twelve weeks in total.

How effective is varenicline?

Varenicline can effectively help you quit smoking. Studies show that it helps about 13 out of 100 people to stop smoking tobacco.

What side effects does varenicline have?

Varenicline caused nausea in about 19 out of 100 people in the studies. But the nausea was often only mild and went away again during the course of the treatment. About 5 out of 100 people had sleep problems and/or strange dreams.

The aim of gradually increasing the dose at the beginning of the treatment is to prevent side effects like nausea. People who still don’t tolerate varenicline well can reduce the dose by half (two 0.5 mg tablets per day). If you has advanced kidney failure, you shouldn’t take more than 1 mg per day.

Is varenicline safe?

Serious side effects of varenicline are very rare to non-existent. Several studies involving more than 10,000 participants didn’t show any risks. But a small risk cannot be ruled out completely. So it’s a good idea for people who have chronic diseases to point out their health problems to the doctor before using varenicline.

Are other medications available?

Some other medications, including some antidepressants and plant-based medicines made from St. John’s wort, are also considered as treatments for quitting smoking. But they are not well studied for this purpose. Studies done so far don’t show that they can help.

Batra A, Kiefer F, Andreas S et al. S3-Leitlinie „Rauchen und Tabakabhängigkeit: Screening, Diagnostik und Behandlung“. AWMF-Registernr.: 076-006. 2021.

Benowitz NL, Pipe A, West R et al. Cardiovascular Safety of Varenicline, Bupropion, and Nicotine Patch in Smokers: A Randomized Clinical Trial. JAMA Intern Med 2018; 178(5): 622-631.

Cahill K, Lindson-Hawley N, Thomas KH et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2016; (5): CD006103.

Howes S, Hartmann-Boyce J, Livingstone-Banks J et al. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2020; (4): CD000031.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Benefit assessment of bupropion, cytisine, nicotine and varenicline for smoking cessation in severe tobacco dependence. Final report; Commission A22-34. 2023.

Sterling LH, Windle SB, Filion KB et al. Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2016; 5(2): e002849.

Thomas KH, Martin RM, Knipe DW et al. Risk of neuropsychiatric adverse events associated with varenicline: systematic review and meta-analysis. BMJ 2015; 350: h1109.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Medication for quitting smoking

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Updated on September 7, 2022

Next planned update: 2025

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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