Prescription Medications to Quit Tobacco

Prescription medications do not contain nicotine but reduce cravings and withdrawal symptoms by affecting how nicotine interacts with your brain. Using quitting medications can increase your chances of quitting smoking successfully. They are even more effective when combined with counselling support.

Brand Name
Name
Advantage
PharmaCare BC Coverage
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Champix®
Varenicline
Blocks effects of nicotine
YesCovered by PharmaCare BC

Varenicline (brand name Champix®) is only available by prescription to your doctor. It blocks the effects of nicotine and reduces cravings and withdrawal symptoms. If you start smoking again while taking the medicine, you will not feel as satisfied. This improves your chances of quitting.

Varenicline is one of two prescription medications covered under the PharmaCare BC Smoking Cessation program. *Please note that Champix® is now only covered as a partial benefit under PharmaCare. Ask your doctor about the low-cost (generic) alternatives.

Learn more about your coverage.

Effectiveness

Evidence suggests that varenicline is the most effective medication for helping people quit. When used as directed, there is evidence that varenicline can increase your chances of quitting successfully.

Advantages

Varenicline works by changing the way the brain reacts to nicotine. It makes it harder to get pleasure to nicotine and also helps to reduce cravings by blocking the receptor in the brain that responds to nicotine. Other advantages include:

  • It is easy to use
  • It does not contain nicotine

Common side effects

  • Nausea and vomiting
  • Gas and constipation
  • Insomnia and abnormal dreams
  • Headache
  • Mood and behavioural change
How to use

Varenicline is available as a pill that you take by mouth.

  • Start taking varenicline one week before you quit smoking. This builds up the level of medicine in your body
  • Continue to smoke as usual while taking varenicline until your quit date
  • The recommended dose of varenicline to help you quit smoking is:
    • Days 1-3: take one 0.5mg tablet once a day
    • Days 4-7: take one 0.5mg tablet twice a day, once in the morning and once at night
    • Day 8 to the end of treatment: take one 1mg tablet twice a day, once in the morning and once at night
  • Take varenicline after eating and with a full glass of water to decrease nausea and vomiting side effects
Warnings and precautions

As with any prescription medication, there are benefits and risks to taking varenicline. Health Canada has determined that for varenicline, the benefits outweigh the risks.

Heart or stroke events

Talk to your doctor if you have any changes in cardiovascular symptoms, including:

  • Chest discomfort for more than a few minutes or that goes away and comes back
  • Pain or discomfort in one or both arms, back, neck, jaw or stomach
  • Shortness of breath, sweating, nausea, vomiting, or feeling lightheaded associated with chest discomfort

Get emergency medical help right away if you have symptoms of a stroke, including:

  • Weakness or sudden numbness in the face, arm or leg even if temporary
  • Trouble speaking, even if temporary
  • Vision problems, even if temporary

Do not use if one of the following applies to you:

  • Have an allergy to varenicline
  • Currently using nicotine replacement therapy (like gum or patch). The combination of taking both does not increase your chance of quitting and increases the likelihood of experiencing side effects
  • Less than 18 years old
  • You are pregnant

Speak to a doctor or pharmacist
About whether varenicline is right for you if one of the following applies to you:

  • Depression or other mental health problems
  • Breast-feeding
  • Kidney problems
  • Currently taking medications such as insulin, theophylline, or warfarin

Stop taking if varenicline and speak to your doctor immediately if you experience any of the following symptoms:

  • Depressed mood
  • Agitation
  • Changes in behaviour that are not typical
  • Suicidal thoughts or behaviour
  • Thoughts of harming yourself or others
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Zyban®
Bupropion
Makes smoking less pleasurable
YesCovered by PharmaCare BC

Bupropion (Zyban®) is one of two prescription medications covered under The PharmaCare BC Smoking Cessation program.

Learn more about your coverage.

Effectiveness

When used as directed, there is evidence that buproprion can increase your chances of quitting successfully.

Advantages

Buproprion is a prescription-only drug treatment that works by changing the brain's response to nicotine. It makes smoking less pleasurable and reduces cravings while you work on your smoking habits. Other advantages include:

  • It does not contain nicotine.
  • It can delay weight gain after quitting for some people.

Common side effects
  • Dry mouth
  • Insomnia
  • Headache
  • Shakiness or nervousness
  • Weight loss

How to use

Bupropion is available as a pill that you take by mouth. 

  • Start taking bupropion about two weeks before you quit smoking. This builds up the level of medicine in your body
  • Continue to smoke as usual while taking bupropion until your quit date
  • You can take bupropion with or without food
  • The recommended dose of bupropion to help you quit smoking is:
    • Days 1-3: Take one 150mg tablet once a day in the morning
    • Day 4 to the end of treatment: Take one 150 mg tablet twice a day, once in the morning and once in the early evening (at least 8 hours between doses)
  • The recommended length of bupropion therapy is seven to twelve weeks
Warnings and precautions

As with any prescription medication, there are benefits and risks to taking bupropion. Health Canada has determined that for bupropion, the benefits outweigh the risks.

Do not use bupropion if one of the following applies to you:

  • Currently using bupropion for another reason (such as Wellbutrin for depression)
  • Have an allergy to bupropion
  • Have a seizure disorder
  • Have an eating disorder, such as anorexia or bulimia
  • Heavy alcohol drinker who plans to quit drinking abruptly
  • Currently use or recently (in the last two weeks) have used a class of medications called Monoamine Oxidase Inhibitors (MAO-I)
  • Currently using a drug called thioridazine

Speak to a doctor or pharmacist about whether bupropion is right for you if one of the following applies to you:

  • Liver or kidney problems
  • Pregnant or breast-feeding
  • High blood pressure
  • Less than 18 years old
  • Currently taking medications that can increase your risk of seizures

Stop bupropion and speak to your doctor or healthcare provider immediately if you experience:

  • Agitation
  • Depressed mood
  • Suicidal thoughts or behaviour

BC residents can get up to 12 weeks of coverage for either prescription medications or NRT each calendar year. Learn more about your coverage.

Nicotine Replacement Therapies

Nicotine replacement therapy (NRT) works by providing the body with nicotine to help reduce withdrawal symptoms and cravings. NRT is one of the most effective tools to help people quit tobacco and can increase your chances of quit success. It's even more effective when combined with counselling.

Name
Release Type
Advantage
PharmaCare BC Coverage
Image
NRT_meds_1
Nicotine gum
Release type
Short-acting
Good for occasional smokers
YesCovered by PharmaCare BC
Effectiveness

When used as directed, there is evidence it can increase your chances of successfully quitting.

Advantages

The nicotine gum is good for occasional smokers to reduce withdrawal symptoms, cravings and manage stress. You can use the gum to help you reduce the number of cigarettes you smoke daily.

Common side effects

Nicotine gum is not like regular gum. If used incorrectly, you are more likely to experience side effects, including:

  • Nausea
  • Stomach upset
  • Mouth, throat or gum irritation
  • Jaw ache
  • Hiccups
  • Headaches
  • Trouble sleeping
How to use

Note: The taste of nicotine gum can be unpleasant at first but most people get used to it with regular use.

  • Nicotine gum should not be chewed like regular chewing gum. Use bite-park technique. 'Bite' the gum once or twice, then “park” the gum in the corner of your mouth (between your cheek and gums)
  • Wait one minute, bite the gum a few more times, and then “park” the gum again
  • Repeat the 'bite' and “park” process for 30 minutes
  • It takes 15 to 30 minutes for the gum to start working so use the gum prior to when you think you will need it. For instance, if you used to smoke on your coffee break, take the gum 30 minutes prior to your regular break
  • Avoid acidic food or beverages like coffee, tea, juice, and soda 15 minutes before using the gum. The acid in these products can prevent your mouth from absorbing the nicotine in the gum
Warnings and precautions

If you have an active jaw disease or jaw/dental pain you should use a different form of nicotine replacement therapy, as these conditions will make it difficult to use the gum.

Consult your doctor or pharmacist prior to starting the gum if the following apply to you:

  • Pregnant or breastfeeding
  • Have heart arrhythmias, have had a heart attack or have angina pectoris
  • Heart attack or stroke within the last two weeks
  • Require kidney dialysis
  • Use any prescribed medication regularly. Smoking alters the effects of some medications, and when you quit smoking it may be necessary for your doctor to adjust the doses, especially if you are diabetic, taking medications for high blood pressure or heart disease, or taking antidepressants, tranquillizers or sleeping pills

Stop using the nicotine gum immediately and see your doctor if you experience the following:

  • Chest pain
  • Irregular heartbeat
  • Palpitations
  • Leg pain
  • Persistent stomach pain
Fully covered supply of Nicotine Gum for BC Residents

Each calendar year, eligible BC residents can receive up to a three month supply of Nicorette® gum (2 mg, 4 mg) through the PharmaCare BC Smoking Cessation Program. You can find more information about how to access this program here.

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Nicotine lozenges
Release type
Short-acting
Different strengths available
YesCovered by PharmaCare BC
Effectiveness

When used as directed, there is evidence it can increase your chances of successfully quitting.

Advantages
  • Easy to use
  • Small lozenge that dissolves in the mouth
  • Helps to manage the symptoms of nicotine withdrawal such as breakthrough cravings
  • You can choose the strength of lozenge to use. This is dependent on the number of cigarettes you smoke per day
Common side effects
  • Mouth, throat or tongue irritation
  • Headaches
  • Nausea
  • Hiccups
  • Upset stomach
  • Dizziness
How to use
  • Place one lozenge in your mouth and allow it to dissolve slowly
  • Occasionally move the lozenge to one side of your mouth to the other
  • Do not bite, chew, or swallow the lozenge whole
  • Do not eat or drink while the lozenge is in your mouth
  • Do not use more than 15 lozenges per day
  • The lozenge should take about 20 to 30 minutes to dissolve

Note: There are two strengths of lozenges so talk to your doctor or pharmacist about which strength is right for you. For more information on appropriate dosage, read the package insert or consult your physician or pharmacist.

Warnings and precautions

Do not use the nicotine lozenge if you are:

  • Under the age of 18 years of age
  • Allergic to nicotine or any of the non-medicinal ingredients in the product

Consult your pharmacist or physician prior to using the nicotine lozenge if the following apply to you:

  • Pregnant or breastfeeding
  • Heart problems
  • Thyroid problems
  • Circulation problems
  • Stomach problems
  • High blood pressure
  • Taking insulin
  • Use any prescribed medication regularly. Smoking alters the effects of some medications, and when you quit smoking it may be necessary for your doctor to adjust the doses, especially if you are diabetic, taking medications for high blood pressure or heart disease, or taking antidepressants, tranquillizers or sleeping pills
Fully covered supply of Nicotine Lozenge for BC Residents

Each calendar year, eligible BC residents can receive up to a three month supply of Nicorette® lozenges (2 mg, 4 mg) through the PharmaCare BC Smoking Cessation Program. You can find more information about how to access this program here.

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Nicotine patch
Release type
Long-acting
Good if you smoke heavily
YesCovered by PharmaCare BC
Effectiveness

When used as directed, there is evidence it can increase your chances of successfully quitting.

Advantages
  • Easy to use - just put it on once per day and forget about it
  • Useful for people who smoke heavily who need steady release of nicotine
  • Designed to temporarily replace some of the nicotine that cigarettes would normally supply and thus reduce the symptoms of nicotine withdrawal such as cravings, irritability and anxiety
  • You can choose the strength of the dosage. This is dependent on the number of cigarettes you smoke per day. See below for suggested dosages or talk to your doctor or pharmacist
Common side effects
  • Headaches
  • Cold or flu-like symptoms
  • Dizziness
  • Anxiety
  • Sleep problems
  • Vivid dreams
  • Stomach upset
  • Mild itching, burning and tingling are normal in the first hour of wearing the patch
  • Redness of the skin when the patch is removed

Note: Remove the patch and consult your doctor if you experience chest pain, irregular heartbeat, palpitations, leg pain or persistent stomach upset while using the patch.

How to use the patch
  • Dosing should be individualized based on how much you smoke
  • The patch should be applied and left on the skin for 24 hours per day. Other patch products may be different
  • The patch comes in three patch sizes, which give doses of 21 mg/day (Step 1), 14 mg/day (Step 2) and 7 mg/day (Step 3)
  • Typically a pack-a-day smoker would wear each size for 3 to 4 weeks, gradually reducing nicotine delivery by going to Step 1 to Step 2 to Step 3

Note: For more info on getting the proper dosage, read the package insert, consult with your physician, pharmacist or contact our QuitLine at 1.877.455.2233 and speak with a Quit Coach.

Things to remember
  • Mild itching, burning and tingling are normal in the first hour of wearing the patch
  • Do not use more than one nicotine patch at a time. Using more than one would increase your risk of experiencing side effects
  • Do not cut or trim the patch. This will interfere with how the nicotine is released to the patch. Only use the nicotine patch as directed
  • Remove the patch two hours before prolonged strenuous activity or going scuba diving. These activities may increase your risk of experiencing side effects
  • If you find yourself still craving cigarettes while using the patch, speak with your doctor or pharmacist to see what options (such as using nicotine gum and the patch together) are available for you. But remember that PharmaCare will only cover one smoking cessation aid per calendar year: January 1st through December 31st
 
Warnings and precautions

Do not use the patch if you have severe eczema, psoriasis or other generalized skin disorders.

Consult your pharmacist or physician prior to using the patch if the following apply to you:

  • Pregnant or breastfeeding
  • Being treated for any serious heart condition
  • Heart attack or stroke within the last two weeks
  • Require kidney dialysis
  • Use any prescribed medication regularly. Smoking alters the effects of some medications, and when you quit smoking it may be necessary for your doctor to adjust the doses, especially if you are diabetic, taking medications for high blood pressure or heart disease, or taking antidepressants, tranquillizers or sleeping pills

Stop using the patch immediately and see your doctor if you have:

  • Chest pain
  • Irregular heartbeat
  • Palpitations
  • Leg pain
  • Persistent stomach pain
  • Rash or hives
Coverage of Nicotine Patches for BC Residents 

Each calendar year, eligible BC residents can receive up to a three month supply of Nicoderm® patch (7 mg, 14 mg, 21 mg) through the PharmaCare BC Smoking Cessation Program. You can find more information about how to access this program here.

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Nicotine inhaler
Release type
Short-acting
Choose how often to use it
NoNot covered by PharmaCare BC
Effectiveness

When used as directed, there is evidence it can increase your chances of successfully quitting.

Advantages
  • It mimics the hand-to-mouth action of smoking
  • The user decides how often to use the inhaler
  • Reduces the symptoms of nicotine withdrawal cravings and irritability
Common side effects
  • Nausea
  • Headaches
  • Mouth or throat irritation
  • Stomach upset
How to use
  • Take the mouthpiece out of its plastic wrapper
  • Line-up the markings on the mouthpiece and separate the two pieces
  • Remove one cartridge to the foil wrapped tray
  • Press the cartridge firmly down into the bottom of the mouthpiece until the seal breaks
  • Replace the top of the mouthpiece. Line up the markings
  • Press the cartridge firmly down to break the upper seal of the cartridge
  • Twist the mouthpiece to mis-align the markings
  • With the tapered end of the mouthpiece in your mouth, either take in deep or short puff into the back of the throat
  • Each cartridge will last for about 20 minutes of continuous frequent puffing
  • When the cartridge is empty, remove the cartridge to the mouthpiece and dispose of the cartridge out of reach to children and pets
  • Clean the mouthpiece regularly with soap and water
  • Do not have any acidic beverages like coffee, tea, juice, and soda while using the inhaler. The acid in these drinks can prevent your mouth from absorbing the nicotine in the inhaler
Recommended schedule
  • Use at least 6 to 12 cartridges per day initially
  • Do not use more than 12 cartridges a day
  • As your body adjusts to not smoking, you can choose to stop using the inhaler or slowly reduce the number of cartridges you use a day
  • Do not use the inhaler for more than six months
Warnings and precautions

Consult your pharmacist or physician prior to using the inhaler if the following apply to you:

  • Pregnant or breastfeeding
  • Being treated for any serious heart condition
  • Heart attack or stroke within the last two weeks
  • Require kidney dialysis
  • Use any prescribed medication regularly. Smoking alters the effects of some medications, and when you quit smoking it may be necessary for your doctor to adjust the doses, especially if you are diabetic, taking medications for high blood pressure or heart disease, or taking antidepressants, tranquillizers or sleeping pills

Stop using the inhaler immediately and see your doctor if you have:

  • Chest pain
  • Irregular heartbeat
  • Palpitations
  • Leg pain
  • Persistent stomach pain
  • Rash or hives
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Nicotine mouth spray
Release type
Short-acting
Choose how often to use it
NoNot covered by PharmaCare BC

The spray is NOT covered under the PharmaCare BC Smoking Cessation Program.

Effectiveness

When used as directed, there is evidence it can increase your chances of successfully quitting.

Advantages
  • Controls cravings fast
  • User decides how often to use the mouth spray (i.e. use it only if you need it)
  • Reduces the symptoms of nicotine withdrawal cravings and irritability
Common side effects
  • Tingling lips
  • Hiccups
  • Strong taste – to nicotine
  • Throat irritation
  • Nausea
  • Heartburn
How to use
  • Prime the dispenser - point the nozzle away and press the dispenser several times until a fine mist appears. If the spray is not used for two or more days, this may be repeated
  • Hold dispenser as close to the open mouth as possible – avoid the lips
  • Press the top of the dispenser to release one spray into the mouth
  • Do not inhale while spraying – spray into the mouth, not the throat
  • For best results, do not swallow for a few seconds after spraying
  • If after a few minutes cravings are still present, spray once more
Recommended schedule
  • Use a maximum of two sprays at a time, maximum four sprays per hour
  • Do not use more than 64 sprays per day
  • As your body adjusts to not smoking, you can choose to stop using the mouth spray or slowly reduce the number of sprays you use a day
  • Do not use the mouth spray for more than six months, unless directed to do so by your healthcare provider
  • Do not have any acidic beverages like coffee, tea, juice, and soda while using the mouth spray. The acid in these drinks can prevent your mouth to absorbing the nicotine to the mouth spray
  • It is important to carry the mouth spray with you at all times so that you can respond to your cravings when they occur
Warnings and precautions

Consult your pharmacist or physician prior to using the nicotine mouth spray if the following apply to you:

  • Pregnant or breastfeeding
  • Being treated for any serious heart condition
  • Heart attack or stroke within the last two weeks
  • Require kidney dialysis
  • Use any prescribed medication regularly. Smoking alters the effects of some medications, and when you quit smoking it may be necessary for your doctor to adjust the doses, especially if you are diabetic, taking medications for high blood pressure or heart disease, or taking antidepressants, tranquillizers or sleeping pills

Stop using the nicotine mouth spray immediately and see your doctor if you have:

  • Chest pain
  • Irregular heartbeat
  • Palpitations
  • Leg pain
  • Persistent stomach pain
  • Rash or hives
PharmaCare BC Smoking Cessation Program

Currently, Nicotine Mouth Spray is not covered under the PharmaCare BC Smoking Cessation Program. Availability and price varies by pharmacy.

Combination Nicotine Replacement Therapy

What is combination NRT?

Combination NRT is using two forms of nicotine replacement therapy (NRT) to increase your chance of successfully quitting, as follows:

  • Long-acting NRT (nicotine patch) to provide steady levels of nicotine
  • Short-acting NRT (gum, lozenge, inhaler or spray) to help reduce breakthrough cravings or deal with challenging situations

Effectiveness

  • Combining a long-acting nicotine patch with a short-acting NRT like nicotine gum, when used as directed, can increase quit rates compared to using a single NRT product

Who are good candidates for combination NRT?

Combination NRT may be appropriate for people who:

  • Have used NRT in previous quit attempts but relapsed while using it
  • Feel they need something more than a patch or other single form of NRT to deal with intense cravings to smoke

Talk to your doctor prior to using any kind of combination therapy, including combining NRTs, or combining prescription smoking cessation therapy with NRTs. Be sure to review how to use each NRT product properly, including the warnings and precautions for each product.