Quitting Smoking: Which Medications Improve Your Chances

You have tried to quit before. Maybe you made it a few days or a few weeks, then the cravings won. That is very common. Nicotine is highly addictive, and most people who smoke need several attempts before they quit for good. The good news is that medication and support can greatly improve your odds. This guide compares the options and explains what guidelines recommend.

Why quitting is hard

Nicotine changes brain chemistry. When you stop, you can get withdrawal symptoms such as:

• Strong cravings
• Irritability, anxiety, or low mood
• Restlessness and trouble concentrating
• Trouble sleeping
• More appetite

These symptoms are usually worst in the first week and fade over several weeks. Quit medications ease withdrawal and cravings, which makes it easier to stay quit.

The main medications

Nicotine replacement therapy (NRT)

NRT gives you nicotine without the smoke and its harmful chemicals. Forms include:

• Patches, which give a steady dose all day
• Gum, lozenges, inhalers, mouth sprays, and nasal sprays, which act faster for cravings

Using a long-acting patch together with a short-acting form, called combination NRT, works better than one form alone. Most NRT is available without a prescription in Canada and the US.

Varenicline

Varenicline is a prescription pill that partly activates nicotine receptors in the brain. It reduces cravings and makes smoking less rewarding. A 2023 Cochrane review found that varenicline more than doubled quit rates compared with placebo, and worked better than bupropion or a single form of NRT [3]. Common side effects include nausea, vivid dreams, and trouble sleeping.

Cytisine

Cytisine is a plant-based medication that works in a similar way to varenicline. The same Cochrane review found it more effective than placebo, with results that may be similar to varenicline and fewer side effects [3]. It is authorized in Canada. In the US, it has not been widely available, so ask your clinician about its current status.

Bupropion

Bupropion is an antidepressant that also helps people quit. It is taken for 1 to 2 weeks before your quit date and usually for 7 to 12 weeks after. It is not suitable for people with a seizure disorder or certain eating disorders.

How the options compare

The EAGLES trial was one of the largest quit-smoking trials, with about 8,000 adults [4]. It compared varenicline, bupropion, the nicotine patch, and placebo over 12 weeks of treatment. At the end of treatment, the share of people who had stayed quit for the last month was roughly [4]:

• About 1 in 3 with varenicline
• About 1 in 4 to 1 in 5 with bupropion or the patch
• About 1 in 8 with placebo

What your doctor looks at

US guidance

The USPSTF (US Preventive Services Task Force) gives its highest grade, A, to asking all adults about tobacco, advising them to quit, and offering behavioural support and FDA-approved medication [1]. FDA-approved medications are NRT, varenicline, and bupropion [1]. The USPSTF found too little evidence to recommend e-cigarettes for quitting [1].

Canadian guidance

The Canadian Task Force on Preventive Health Care published its adult tobacco guideline in 2025 [2]. It strongly recommends that everyone who smokes be encouraged to stop and be offered at least one proven method [2]. Recommended options include:

• Advice from a health care provider
• Individual or group counselling
• Text message programs
• Self-help materials
• Bupropion, cytisine, NRT, and varenicline [2]

It recommends against acupuncture, hypnotherapy, laser therapy, and St. John's wort [2]. It suggests against e-cigarettes for quitting, except in certain cases, such as when other methods have not worked, after discussing the uncertainties [2].

Mental health safety

Varenicline and bupropion once carried an FDA boxed warning about mental health side effects. The EAGLES trial found no significant increase in serious neuropsychiatric events with varenicline or bupropion compared with the patch or placebo, including in people with mental health conditions [4]. The FDA removed the boxed warning in 2016. Clinicians still ask about mood changes during treatment.

Other checks

• Kidney function, since varenicline dose may be lowered with kidney disease
• Seizure history, before bupropion
• Pregnancy, since options and evidence differ
• Other medications, since quitting smoking can change the levels of some drugs, such as clozapine

Support makes a difference

Combining medication with counselling works better than either alone [5]. Free quitlines can help:

• Canada: 1-866-366-3667
• US: 1-800-QUIT-NOW (1-800-784-8669)

Questions to ask your clinician

• Which medication is the best fit for my health and smoking pattern?
• Can I combine a patch with gum or lozenges?
• When should I start the medication relative to my quit date?
• What side effects are common, and which ones should I report?
• Is the medication covered by my provincial or insurance plan?
• How long should I stay on treatment?
• What should I do if I slip and smoke?

When to get care quickly

Call 911 for chest pain, trouble breathing, signs of stroke, or a seizure. Get urgent help for thoughts of suicide or sudden, severe mood changes during treatment, or call or text 988 in Canada or the US. Seek care for signs of an allergic reaction, such as swelling of the face or a severe rash.

Bottom line

Quitting smoking is one of the best things you can do for your health, and medication improves your chances. Varenicline, cytisine, and combination NRT are among the most effective options, and bupropion is also helpful. Canadian and US guidelines both recommend offering medication with support to everyone who smokes. Talk to your clinician or pharmacist about the best plan for you.

Primary AI can show you the guideline and study sources behind this topic in plain language, so you can bring better questions to your appointment.