Provide Other Quit Medication Information & Recommendations
The most commonly used quit medication is nicotine replacement therapy (NRT), which is available in several forms.
Patches, gum and lozenges are available without a prescription. Providers must prescribe inhaler, nasal spray and oral quit medications like Zyban® and Chantix®. Providers can decide if an office visit is necessary for a prescription or not.
Guidelines For Treatment Of Adults With Tobacco Dependence
US Preventive Services Task Force (USPSTF) and the American Thoracic Society (ATS) joint guideline for the treatment of tobacco dependence in adults recommends:
- Varenicline over a nicotine patch for adults when treatment is being initiated.
- Varenicline over bupropion for adults when treatment is being initiated.
- Varenicline plus a nicotine patch over varenicline alone for adults when treatment is being initiated.
- Varenicline over electronic cigarettes for adults when treatment is being initiated.
- Clinicians begin treatment with varenicline in tobacco-dependent adults who are not ready to discontinue tobacco use, rather than waiting until patients are ready to stop tobacco use.
- Varenicline over a nicotine patch for adults when treatment is being initiated who have comorbid psychiatric conditions, including substance-use disorder, depression, anxiety, schizophrenia, and/or bipolar disorder.
- Using extended-duration (>12 wk) over standard-duration (6–12 wk) therapy for adults when treatment is being initiated with a controller.
In addition to nicotine replacement therapy, varenicline and bupropion have demonstrated efficacy as tobacco cessation aids. The likelihood of a successful quit attempt is increased if counseling is provided along with medications.
The following items are available by prescription only. Medicaid covers up to 24 weeks of Zyban® or Chantix®. Review the American Thoracic Society Clinical Practice Guideline for Initiating Pharmacologic Treatment in Tobacco-Dependent Adults and the AHRQ’s Clinical Guidelines for Prescribing Pharmacotherapy for Smoking Cessation.
- INHALER: Cartridge attached to a mouthpiece. Inhaling releases a specific amount of nicotine.
- NASAL SPRAY: Pump bottle containing nicotine. Similar to an inhaler, the spray releases a specific amount of nicotine.
- ZYBAN® (BUPROPION): Can be helpful in reducing cravings and withdrawal symptoms, such as anxiety and irritability. May be used in combination with nicotine replacement therapy products like patches, gum and lozenges.
- CHANTIX® (VARENICLINE): Reduces the severity of cravings and withdrawal symptoms—does not contain nicotine. Lessens sense of pleasure from tobacco. Should not be combined with other medications.
There can be side effects from quit medications. Side effects will vary from person to person. However, very few people (less than 5%) have to stop using quit medications because of side effects.
Compared to quitting cold turkey, using quit medications such as nicotine patches, gum and lozenges can dramatically increase the success rate when quitting smoking, vaping or other tobacco. Additionally, when used together, the patch paired with the gum or lozenges can provide much better relief from nicotine cravings than they can when used alone because it combines the power of long-acting support with fast-acting delivery.
The patch delivers a steady stream of nicotine for 24 hours, so patients can receive long-acting, consistent relief from withdrawal symptoms, such as headaches and irritability. Meanwhile, gum or lozenges deliver a small amount of nicotine within 15 minutes, helping patients to manage tough situations as they ride out the cravings.
It’s likely that patients will experience withdrawal symptoms soon after quitting tobacco. These symptoms are the strongest during the first two weeks after quitting and should go away shortly. Withdrawal symptoms are different for everyone. Some of the more common ones include:
- Feeling down or sad
- Trouble sleeping
- Feeling irritable, grouchy or on-edge
- Trouble thinking clearly or concentrating
- Feeling restless and jumpy
- Slower heart rate
- Increased hunger or gaining weight
Free Quit Medications
Check to see if your patients are eligible for free nicotine replacement therapy via 802Quits or their insurance. Review this chart with your patient on nicotine replacement therapy by program.
Other Medication Resources
Medicaid Benefits
In Vermont, Medicaid members qualify for tobacco cessation as a preventive service.