Doses and duration of pharmacological treatments to quit smoking

MedicationMechanism of actionDosage and treatment durationSide-effects
Nicotine replacement therapyActs at the level of nicotinic central nervous system receptors16-h patches
>10 cigarettes per day:
25 mg once daily×6 weeks
15 mg once daily×4 weeks
10 mg once daily×2 weeks
5 mg once daily×2 weeks
<10 cigarettes per day:
10 mg once daily×6 weeks
5 mg once daily×2 weeks
24-h patches
>10 cigarettes per day:
21 mg once daily×6 weeks
14 mg once daily×4 weeks
7 mg once daily×2 weeks
<10 cigarettes per day:
14 mg once daily×6 weeks
7 mg once daily×2 weeks
Redness or itching of skin where patch applied, urticaria, headache, dizziness, nausea/vomiting, insomnia
Chewing gum 2–4 mg or
tablets 1–2 mg if craving
Mouth soreness, throat irritation, jaw ache, dyspepsia, flatulence, nausea, emesis, unpleasant taste, possible allergic reactions
BupropionInhibits neuronal reuptake of dopamine and norepinephrine in the nucleus accumbens and locus coeruleus≥12 weeks:
150 mg per 12 h
First week progressive dose
Insomnia (most common), dry mouth, anxiety, irritability, restlessness, headache, tinnitus, skin rash, seizures (rare and most alarming)
VareniclinePartial agonist for the α4β2 nicotinic acetylcholine receptor (dopamine release in the nucleus accumbens)≥12 weeks:
Days 1–3: 0.5 mg once daily
Days 4–7: 0.5 mg twice daily
Days 8+: 1 mg twice daily
Nausea (most common), insomnia, abnormal dreams, sleep disturbance, dyspepsia, abdominal pain, constipation, flatulence, emesis, dizziness, dry mouth