Quitting smoking at a glance

Many people who smoke decide at some point to quit. Yet it is often difficult to act on this decision. About half of those who try to quit do succeed without extra help. But it usually takes several attempts until they are able to actually kick the habit. This fact sheet provides you with an overview of different things that can help you to quit smoking. You will also find out how many people profit from them, and which adverse effects may arise. The research results that we present are based on conclusive scientific trials. You can read about how these trials are done and why they are important here.

What are my options for getting help to quit smoking?

If you would like to quit smoking, there are different things you can try out to kick the habit. Many people receive important support from their partner, friends or family. Another option is to get advice on quitting smoking from a doctor or a pharmacist. It can also motivate you to set personal goals and then reward yourself when you have reached them – for instance, by taking a trip or getting yourself a new item of clothing. Some people are helped by the thought that they will save a lot of money if they stop smoking. You can find out how much money you personally spend on cigarettes by using our cigarette calculator.

There are also a lot of brochures and information available for helping people quit smoking. For example, the German Federal Center for Health Education (BZgA) offers various means of support (all in German): there you can order brochures, calendars and diaries free of charge, or download them as PDF files. The BZgA also provides a free internet-based quitting smoking program. You can sign up for it here. The BZgA also runs a hotline for counseling people who are quitting smoking (also in German). There is a charge for the counseling. You can find more information about this as well as the telephone number here. There are also many different courses for quitting smoking. A part of the costs for these courses is covered by some German statutory health insurance funds.

Medications that help to quit smoking

Treatment options involving the use of medication include mainly nicotine replacement therapy and the drugs bupropion and varenicline. In most trials studying nicotine replacement therapy or medication for quitting smoking, participants received extra support as well. This meant, for instance, also getting informational brochures, having short regular counseling sessions or taking part in a special stop-smoking training. Because of this, any conclusions drawn about the effectiveness of nicotine replacement therapy or medication for quitting smoking are only valid when people who use them also receive an additional form of support.

Nicotine replacement therapy: helpful and well tolerated

Quitting smoking is usually especially difficult in the first week. The body does not get its usual nicotine and there are withdrawal symptoms: restlessness, hostility or depression, and a craving for cigarettes. Many people find it harder to concentrate as well, and have more of an appetite than usual. The aim of nicotine replacement therapy is to relieve these withdrawal symptoms.

Nicotine replacement therapy takes different forms: in Germany, nicotine chewing gums, inhalers, patches, tablets and lozenges are all available. You can buy them over the counter at a pharmacy. Even though the term “nicotine replacement therapy” implies something quite different, nicotine is not replaced by another substance in this type of treatment. The body continues to be supplied with nicotine, which in nicotine replacement therapy has a therapeutic function.

An analysis of scientific trials shows that nicotine replacement therapies are effective – especially in people who smoke more than 10 cigarettes a day. The exact results of the trial: Out of 100 people who did not do nicotine replacement therapy, only about 10 of them quit smoking after 6 months (10%). Out of 100 people who used nicotine replacement therapy, 17 people succeeded in giving up cigarettes (17%). So 7 out of 100 people were helped by nicotine replacement therapy (7%).

Most people tolerate nicotine replacement therapy well. In some people nicotine patches cause skin irritation or a rash. Nicotine chewing gum sometimes causes jaw pain or stomach or bowel problems. You can find more information about nicotine replacement therapy here.

Bupropion: greater chances of success, but frequently causes insomnia

Bupropion is an antidepressant that is also approved for quitting smoking. It is prescription-only, so it has to be prescribed by a doctor. Researchers systematically analyzed trials on this medication. These trials showed that bupropion helped about 8 out of 100 people to quit smoking (8%).

On the other hand, bupropion frequently causes adverse effects. It triggers insomnia in about 1 to 3 out of every 10 people (10 to 30%). Other adverse effects include dry mouth and nausea. Sometimes bupropion also causes seizures – but this is rare. The US regulatory authority FDA also issued a safety alert that there had been individual cases of people becoming depressed or having suicidal thoughts and behaving unusually after taking bupropion. You can find more information about this here.

The researchers also analyzed trials on other antidepressants to find out whether they are also effective in helping to quit smoking. Yet they did not find any clear evidence that other antidepressants also have a benefit for people quitting smoking.

Varenicline: can help, but often leads to nausea

Another medication used for quitting smoking is varenicline. It was approved as a new drug in Europe in 2006 under the trade name Champix. It was designed to have a double effect: on the one hand it relieves the nicotine withdrawal symptoms; on the other, it reduces the pleasure taken in smoking.

Varenicline makes it easier to quit smoking: Trials show that it helps about 13 out of every 100 people to stop smoking for at least half a year (13%). But varenicline also has some adverse effects. The most common is nausea: about 20 out of every 100 people taking varenicline experience nausea (20%). Other frequent adverse effects are insomnia, headaches and unusual dreams.

Since varenicline was approved several safety warnings about it have been issued. The regulatory bodies from Europe (EMA) and from the USA (FDA) warned that varenicline could increase the risk of heart attack or other cardiovascular diseases. What is more, these agencies warned that some people were depressed, had suicidal thoughts, or behaved strangely after taking varenicline. Because there were also reports of drowsiness, the FDA advises people to take care when driving or operating heavy machinery if they do not know how they react to varenicline. Because these severe adverse effects are rare, it is difficult to establish a clear connection to varenicline. As a precaution, the authorities do recommend watching for these signs when taking varenicline. You can find more information on varenicline here.

Complementary medicine: hypnosis, acupuncture and other methods put to the test

The complementary medical methods used to quit smoking include hypnosis and acupuncture. But they are not as well researched as nicotine replacement therapy, for example. A recent analysis of 33 trials on conventional acupuncture with needles, acupressure, as well as laser and electro acupuncture had contradictory results. It therefore remains unclear whether one of these interventions increases the chances of successfully quitting smoking in the long term. More research is needed to actually assess the effect.

What helps in pregnancy?

Smoking during pregnancy increases the risk of a woman having a miscarriage, and of the baby being born too early or weighing too little. For this reason, many women stop smoking before or during pregnancy. But this is not easy for all women and many need support to quit. There are different kinds of programs designed to help pregnant women stop smoking. In these programs they receive counseling and are able to speak with others in the same situation. These types of programs do not make use of medication.

Trials show that stop-smoking trainings for pregnant women increase their chances of success. With this help, an additional 4 out of every 100 women succeed in not smoking in pregnancy (4%). This figure does not seem that high at first glance, but success is not only an advantage for the women themselves, but for their babies as well: researchers found that children born to women who participated in a stop-smoking training were less likely to be born too early or underdeveloped. You can read more about quitting smoking in pregnancy here.

Will quitting smoking affect my weight?

Most people who quit smoking do gain some weight. Especially in the first year the gain in weight can be noticeable. Weight gain during this time averages about 5 kilograms. The reason is not only eating more or snacking more often– your metabolism changes as well. Smoking also suppresses your appetite. But the weight gain is not necessarily permanent.

Author: German Institute for Quality and Efficiency in Health Care (IQWiG)

Next planned update: August, 2014. You can find out more about how our health information is updated here.

© IQWiG (Institute for Quality and Efficiency in Health Care)