Don't try to quit by willpower alone; get medicine first, which more than doubles your chance of success
- High value
- Evidence A
- Buys life
- Costs a little
- Takes minutes
- Some willpower
In plain words
People who take varenicline succeed more than twice as often as people who take a placebo. People who use replacements such as nicotine patches or gum do about 50% better than people who use no medicine. Using the patch and the gum together adds more than another 20%.
- Cost
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Nicotine patches and nicotine gum are over-the-counter drugs, sold at the pharmacy counter. A course lasts 8 to 12 weeks and costs a few hundred to a bit over 1000 CNY. Varenicline and bupropion are prescription drugs, prescribed at a quit-smoking clinic or a respiratory medicine department. The cost roughly cancels out against the cigarettes you no longer buy over the same period.
- What you get
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Pooling 41 randomized trials with 17395 people, the quit rate in the varenicline group was 2.32 times that in the placebo group (RR 2.32, 95% CI 2.15โ2.51, the plausible range; high-certainty evidence). Varenicline also did better than bupropion (RR 1.36, about 36% higher) and than a single nicotine replacement product (RR 1.25, about 25% higher). Nicotine replacement compared with no medicine: 133 trials with 64640 people, with success about 55% higher (RR 1.55, 95% CI 1.49โ1.61). A patch plus a fast-acting form (gum or lozenge) did about 27% better than a single product (RR 1.27, 95% CI 1.17โ1.37, 16 trials, 12169 people, high-certainty evidence). Side effects: compared with placebo, people taking varenicline were about 2.6 times as likely to have nausea (RR 2.61), about 37% more had insomnia (RR 1.37), and more had vivid dreams. The review says nausea is the most common, mostly mild to moderate, and generally fades gradually. The instructions for one U.S. nicotine patch taper the dose in three steps: 21 mg for 6 weeks, then 14 mg for 2 weeks, then 7 mg for 2 weeks, then stop.
- Notes
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The quit-smoking medicines sold in China are the three kinds above, and only nicotine replacement is available without a prescription. The common side effects of varenicline are nausea, vivid dreams and poor sleep; tell your doctor if you have a history of psychiatric illness; this is the author's advice. A course of nicotine replacement usually lasts 8 to 12 weeks. Patches are tapered step by step and then stopped, following the package instructions or your doctor. Medicine only handles the discomfort of the withdrawal weeks, not the situations that make you want to smoke, so use it together with ยง2.4 (set a quit day) and ยง2.5 (go to a quit-smoking clinic).
- Evidence grade
- A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
- Sources
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- Livingstone-Banks J, Fanshawe TR, Thomas KH, et al. (2023). Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD006103. https://doi.org/10.1002/14651858.CD006103.pub8
- Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T (2018). Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD000146. https://doi.org/10.1002/14651858.CD000146.pub5
- Theodoulou A, Chepkin SC, Ye W, et al. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD013308. https://doi.org/10.1002/14651858.CD013308.pub2
- Shanghai Municipal Health Commission (2021). Choosing the Right Medication Makes Quitting a Little Easier [in Chinese]: "The smoking cessation drugs on the market are mainly of three kinds: nicotine replacement therapy drugs, bupropion and varenicline", "Nicotine replacement therapy drugs are over-the-counter (OTC) drugs and can be bought at a pharmacy counter; bupropion and varenicline are prescription drugs, which you must see a doctor for at a hospital smoking cessation clinic or respiratory medicine department, and can only get after a pharmacist fills a doctor's prescription". https://wsjkw.sh.gov.cn/jtyx/20211119/df50681e01ba49f896d54f771d8176ae.html
- Haleon (2025). NICODERM CQ (nicotine) patch, extended release. DailyMed label: "use according to the following 10-week schedule: STEP 1 โฆ 21 mg patch/day โฆ Weeks 1-6 โฆ 14 mg โฆ Weeks 7-8 โฆ 7 mg โฆ Weeks 9-10". https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=93b2d1b9-83c1-40b5-b6af-90c38c8d6cef (the patch step-down sentence)
Mentioned in
- Quit smoking, and the earlier the better
- Go to a quit-smoking clinic, or call 12320 (China's public health hotline) to ask whether there is a quit-smoking service near you
- Consider e-cigarettes only if you really can't quit otherwise, and don't touch them if you don't already smoke
- Put your own money on the line to make yourself follow through, but first ask whether you would be willing to
- If you have COPD (chronic obstructive pulmonary disease, ๆ ข้ป่บ), have your doctor or pharmacist watch you use your inhaler once at each follow-up visit; if you have been hospitalized for an acute flare-up, go to pulmonary rehabilitation after you leave the hospital
Translated from the Chinese original. Original book, section 2, tip 3. This section is about health and medicines. It is general information, not a substitute for a doctorโs diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer