Depending on the severity of tobacco dependence, your patient who is trying to quit might benefit from nicotine replacement therapy (e.g. nicotine patch, gum, nasal spray), prescription drugs, or both. Below is a reference that first lists commonly prescribed FDA-approved cessation medications, then FDA-approved drugs for purposes other than cessation that have shown promise for aiding cessation, and lastly, some drugs currently being studied for efficacy as a cessation aide.
Commonly prescribed cessation medications
Bupropion (Wellbutrin; Zyban)
Bupropion is especially effective for smokers with comorbid depressive symptoms. This drug has been shown to decrease nicotine craving and lessen withdrawal symptoms.
Varenicline interferes with neural responses to nicotine exposure, which in turn decreases the pleasurable effects of smoking and diminishes some aspects of withdrawal.
Current research is examining whether long-term cessation rates are better when Varenicline is prescribed in tandem with nicotine replacement therapy or bupropion. These studies have yielded mixed results so far.
Other medications often prescribed for cessation
This medication has also been adapted for smoking cessation after initially being marketed as an antidepressant. However, its effectiveness as a cessation aid has been demonstrated separately from its antidepressant actions.
Because Nortiptyline appears to be an equally effective alternative to bupropion and nicotine replacement therapies, more research comparing its efficacy to other mainstream cessation medications like varenicline is currently underway.
Originally FDA-approved to treat high blood pressure, and serving as effective ADHD intervention, Clonidine has also been shown to help people quit smoking.
Clonidine is available as a tablet and transdermal patch.
Other interventions currently under study
According to some studies, cytisine appears to be a more effective cessation than nicotine replacement therapy when both were paired with brief behavioral support. Further investigations of this drug’s efficacy relative to commonly prescribed medications are currently underway.
The National Institute on Drug Abuse has been funding clinical trials examining the efficacy of this novel approach. Results to date are inconclusive.