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Using Medication to Quit Smoking & Vaping – what you need to know

Quitting smoking and vaping can be hard: nicotine withdrawal, cravings, and mental effects all play a role. We’ll explain how medication can help you kick the smoking habit.

Tried everything? It might be time for meds.

Written by: Jack Health Team
Reviewed by: Sarah Bento-De Sousa PharmD. RPh

Quitting smoking and vaping can be a daunting task. And if you’re one of the 70% of Canadians that want to quit, you’ve probably tried a few times already.
Luckily, there are a few medications that can help reduce your cravings and set you on a path of long term quitting. From Champix, Zyban, and Nicotine Replacement Therapy, this guide will help you find the perfect product for you. Of course, you’ll need to speak to a medical professional to double check these options are a good fit and then get the required prescription. We can help.

How do these medications stop smoking cravings?

These medications primarily focus on receptors within your brain, either blocking or changing how your brain registers cravings. This will reduce the ‘pleasurable’ effects of smoking and vaping, making it feel like a chore or gross. And if something is gross or annoying to do, the chances are much lower that you’ll do it!

When should you stop smoking or vaping after starting a medication?
It’ll depend on the medication you end up using: for example, don’t stop or decrease your smoking until at least one week on Champix to ensure there is enough time for the medication to build up in your body and start working. Your medical team will tell you exactly when you should stop smoking or vaping while on the meds.

Nicotine withdrawal – it’s real and can be nasty

Upon starting medication, you may experience nicotine withdrawal symptoms that can be confused with side effects from the medications above. Over time, these withdrawal symptoms should subside. Common nicotine withdrawal symptoms include difficulty sleeping, mood changes (irritability, frustration, anger), depressed mood, restlessness, and increased appetite.^[1]

Should you stop taking the medication if you experience side effects?
If you experience side effects at the beginning, realize that it will take some time for your body to adjust. If you power through the first little bit, your body should eventually get used to the medication, and your side effects may subside. Nicotine withdrawal symptoms can also be confused with medication side effects at the beginning of your quit journey. Remember that side effects are possible and are likely to subside over time.

You’ll likely be on smoking or vaping cessation medication for a few months

Smoking cessation medications are typically used for a minimum of three months. Your health care provider may give you an additional three month supply based on your quit journey and original habits.

Here’s some of the most commonly prescribed medications to stop smoking and vaping

Champix (Varenicline) – Prescription

Champix is thought to work on the nicotine (the addictive ingredient) receptors in the brain which are associated with smoking addiction.^[1] This drug tightly binds the nicotine receptor, blocks nicotine from binding, and mimics the action of nicotine. Essentially, the nicotine can’t sneakily influence your brain anymore! In one 2016 study, more participants quit successfully on Champix (varenicline) than Zyban (bupropion) or nicotine replacement therapy.^[2]

How it works

If you are looking for flexibility, Champix may be a great fit for you! With this drug, you can slowly titrate down from your initial total daily tobacco use until you are no longer smoking. You don’t have to cold turkey quit right away – you have the choice to decide when to stop smoking.

There are three different strategies that can be used.^[1]:

Strategy	Fixed quit approach	Flexible quit approach	Gradual quit approach
Start Date	Week 1-2 after starting medication	Week 2-5 after starting medication	Week 12 after starting medication

Side Effects of Champix

Common side effects include nausea, vomiting, sleep disturbances, headache, and abnormal dreams.^[1]

If you experience side effects after a Champix dose increase, fear not! The evidence we have suggests that quit rates are similar between low and high doses.^[1] Definitely talk to your healthcare team so they can work with you to find the right dose to reduce the side effects.

Other smoking cessation medication options

Zyban (Bupropion) – Prescription

Zyban is thought to help reduce cravings by increasing levels of dopamine (a pleasure hormones) and noradrenaline (a fight-or-flight hormone) in the brain.^[3]Although the drug is not known to have a direct effect on nicotine, it has been shown to help patients quit smoking. In one 2020 study, Zyban was shown to be as effective as nicotine replacement therapy (NRT) ^[4]

How it works

Unlike Champix, you don’t have as much flexibility when setting a quit date with Zyban. It’s recommended that you quit by the end of week two after starting this medication. Despite the lack of flexibility, there are some other benefits to Zyban. Since Zyban is an antidepressant by class, it can help with any mood related symptoms you may have. However it may not be recommended if you are currently on a stable regime of antidepressants – wouldn’t want to mess with what is working for you.

Side effects

Common side effects include sleep disturbances, dry mouth, and nausea.^[3] Again, chat with your medical team to see what they can do to help reduce these issues.

If you aren’t interested in prescription medications, there is Nicotine Replacement Therapy (NRT)

There are many nicotine products on the market that can help you quit smoking without having to take prescription medications.^[5] Oftentimes people will combine NRT with prescription drugs to help change how their brain handles cravings, as well as their mouth and hands.

Product	Peak effect	Benefits
Gum	20-30 minutes	Nicotine gum isn’t like regular gum. You have to chew it a few times and park the gum in your cheek to ensure the nicotine is absorbed. It also keeps your mouth busy so you are less tempted to get out the cigarettes or vape pen.
Lozenge	20-60 minutes	Lozenges are slowly dissolved in the mouth. You don’t have to chew them, so it really comes down to personal preference when choosing between lozenges or gum.
Mouth Spray	15 minutes	If you want something that works fast and mimics the hand-to-mouth motion of a cigarette, the mouth spray may be best for you.
Inhaler/vapes	15 minutes	If you want to trick your brain into thinking you’re still using a cigarette, this product may be for you! The familiar hand-to-mouth motion and inhalation can help replace your cigarettes. This should be a short term way of reducing the habit however, not as a replacement for other tobacco products.
Patch	2-6 hours	If you’re looking for a relatively low maintenance option to help quit smoking, the patch may be for you!

Let’s talk about vapes, baby

For years, nicotine was considered to be comparatively harmless but addictive. However, recent studies show this may not be the case. While nicotine through a vape is the lesser evil (compared to tobacco based cigarettes, cigars or dip/chewing tobacco), it isn’t safe like originally thought.

Below is a list of potential negative effects from long term e-cigarette/vape use:

1. Impaired wound healing and blood vessel formation^[6]

2. Increased blood pressure and heart rate^[7,8]

3. Breathing problems (ie. asthma, increased coughing)^[9–13]

4. Bladder cancer^[14]

5. Chronic musculoskeletal pain^[15]

Vapes are helpful for smoking cessation, not as a stand in for other tobacco products

It’s important for consumers to be educated about the potential danger of using e-cigarettes – especially, for those who are using them recreationally and not for smoking cessation. Remember, while nicotine is better than cigarettes, cigars or dip, our ultimate goal should be to not be dependent on any smoking products.

Quitting tobacco is hard – be kind to yourself

Quitting smoking is a journey. Remember that success can take time and looks different for everyone. Having regular appointments with a healthcare provider who provides counselling can help keep you on track.

Works Cited

1. Champix Product Monograph [Internet]. Pfizer Canada Inc. Kirkland, QC; 2019 [cited 2022 Aug 12]. Available from: https://www.pfizer.ca/sites/default/files/201902/Champix_PM_221214_22Jan2019_EN.pdf

2. Cahill K, Lindson-Hawley N, Thomas KH, Fanshawe TR, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev [Internet]. 2016 May 9 [cited 2022 Aug 12];2016(5). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006103.pub7/full

3. Zyban Product Monograph [Internet]. Valeant Canada LP. Laval, QC; 2016 [cited 2022 Aug 12]. Available from: https://pdf.hres.ca/dpd_pm/00036009.PDF

4. Howes S, Hartmann-Boyce J, Livingstone-Banks J, Hong B, Lindson N. Antidepressants for smoking cessation. Cochrane Database Syst Rev [Internet]. 2020 Apr 22 [cited 2022 Aug 12];2020(4). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000031.pub5/full

5. Petrasko K, Reeve C. Smoking Cessation [Internet]. In: Compendium of Therapeutic Choices for Minor Ailments; 2018 [cited 2022 Aug 12]. Available from: https://myrxtx-ca/search

6. Liu Z, Zhang Y, Youn JY, Zhang Y, Makino A, Yuan JXJ, et al. Flavored and Nicotine-Containing E-Cigarettes Induce Impaired Angiogenesis and Diabetic Wound Healing via Increased Endothelial Oxidative Stress and Reduced NO Bioavailability. Antioxidants (Basel, Switzerland) [Internet]. 2022 May 1 [cited 2022 Aug 12];11(5). Available from: https://pubmed.ncbi.nlm.nih.gov/35624768/

7. Larue F, Tasbih T, Ribeiro PAB, Lavoie KL, Dolan E, Bacon SL. Immediate physiological effects of acute electronic cigarette use in humans: A systematic review and meta-analysis. Respir Med [Internet]. 2021 Dec 1 [cited 2022 Aug 12];190. Available from: https://pubmed.ncbi.nlm.nih.gov/34808583/

8. Gonzalez JE, Cooke WH. Acute effects of electronic cigarettes on arterial pressure and peripheral sympathetic activity in young nonsmokers. Am J Physiol Heart Circ Physiol [Internet]. 2021 Jan 1 [cited 2022 Aug 12];320(1):H248–55. Available from: https://pubmed.ncbi.nlm.nih.gov/33164580/

9. Li X, Zhang Y, Zhang R, Chen F, Shao L, Zhang L. Association Between E-Cigarettes and Asthma in Adolescents: A Systematic Review and Meta-Analysis. Am J Prev Med [Internet]. 2022 Jun 1 [cited 2022 Aug 12];62(6):953–60. Available from: https://pubmed.ncbi.nlm.nih.gov/35337694/

10. Chand BR, Hosseinzadeh H. Association between e-cigarette use and asthma: a systematic review and meta-analysis. J Asthma [Internet]. 2022 [cited 2022 Aug 12];59(9). Available from: https://pubmed.ncbi.nlm.nih.gov/34433366/

11. Chaffee BW, Barrington-Trimis J, Liu F, Wu R, McConnell R, Krishnan-Sarin S, et al. E-cigarette use and adverse respiratory symptoms among adolescents and Young adults in the United States. Prev Med (Baltim) [Internet]. 2021 Dec 1 [cited 2022 Aug 12];153. Available from: https://pubmed.ncbi.nlm.nih.gov/34418439/

12. Sreedharan S, Mian M, Robertson RA, Rhodes A. Radiological findings of e-cigarette or vaping product use associated lung injury: A systematic review. Heart Lung [Internet]. 2021 Sep 1 [cited 2022 Aug 12];50(5):736–41. Available from: https://pubmed.ncbi.nlm.nih.gov/34130236/

13. Bourke M, Sharif N, Narayan O. Association between electronic cigarette use in children and adolescents and coughing a systematic review. Pediatr Pulmonol [Internet]. 2021 Oct 1 [cited 2022 Aug 12];56(10):3402–9. Available from: https://pubmed.ncbi.nlm.nih.gov/34407315/

14. Bjurlin MA, Matulewicz RS, Roberts TR, Dearing BA, Schatz D, Sherman S, et al. Carcinogen Biomarkers in the Urine of Electronic Cigarette Users and Implications for the Development of Bladder Cancer: A Systematic Review. Eur Urol Oncol [Internet]. 2021 Oct 1 [cited 2022 Aug 12];4(5):766–83. Available from: https://pubmed.ncbi.nlm.nih.gov/32192941/

15. Dai Y, Huang J, Hu Q, Huang L, Wu J, Hu J. Association of Cigarette Smoking with Risk of Chronic Musculoskeletal Pain: A Meta-Analysis. Pain Physician [Internet]. 2021 [cited 2022 Aug 12];24(8):495–506. Available from: https://pubmed.ncbi.nlm.nih.gov/34793634/