Therapy	Formulations/maximum dose	Instructions for use	Adverse effects	Comments
Controllers
Bupropion	150-mg extended-release tablet Maximum = 300 mg per day	150 mg per day for three days, then 150 mg twice per day with at least eight hours between doses	Insomnia, anxiety, difficulty concentrating, dry mouth, headache, rash, nausea, dizziness, constipation, seizures (1 per 1,000 patients)	Prescription May delay weight gain associated with quitting; may be helpful for patients with coexisting depression Contraindicated in patients with a history of seizures or eating disorders, who are taking medications that lower seizure threshold, or who have used an MAOI in the preceding 14 days Also contraindicated with abrupt cessation of alcohol, barbitu-rates, benzodiazepines, or antiepileptics Dose adjustment recommended for hepatic impairment
Varenicline (Chantix)	0.5- or 1-mg tablet	Start one week before quit date; alternatively, start while smoking and quit on day 8 to 35 of treatment Take 0.5 mg once per day for three days, then 0.5 mg twice per day for four days, then 1 mg twice per day until the end of treatment (12 weeks); take with food and a full glass of water If patients need to decrease their smoking gradually, consider reducing smoking by 50% by week 4 of treatment, by another 50% by week 8, and then reach abstinence by week 12 Continue treatment for an additional 12 weeks after cessation	Nausea, vomiting, constipation, flatulence, insomnia, abnormal dreams, headache, fatigue	Prescription Dose adjustment is recommended for stage 4 kidney disease No difference in the risk of neuropsychiatric events for patients with and without psychiatric illness compared with placebo; U.S. Food and Drug Administration boxed warning has been removed
Nicotine transdermal patch*	7-, 14-, or 21-mg extended-release patch	Patches should be changed daily For heavy smokers (> 10 cigarettes per day), start at 21 mg per day and gradually taper; suggested regimen is 21 mg for four weeks, then 14 mg for two weeks, then 7 mg for two weeks For smokers of ≤ 10 cigarettes per day, start at 14 mg per day and gradually taper; suggested regimen is 14 mg for six weeks, then 7 mg for two weeks	Skin reactions (erythema, itching, burning), headache, sleep disturbances (insomnia, vivid dreams)	Prescription and OTC May remove patch at bedtime if associated with significant sleep disturbances; not advised for use in patients with severe eczema, psoriasis, or other major skin disorder; should be removed before magnetic resonance imaging to prevent burns
Relievers*
Nicotine gum	2- or 4-mg gum Maximum = 24 pieces per day	Preload or start on quit date Chew gum slowly, and park between cheek and gums once peppery taste or tingling sensation occurs; resume chewing when taste or tingling fades Repeat chew and park steps Discard gum when taste or tingling does not return with chewing Avoid food and drink for 15 minutes before and after use Use 4-mg dose if craving cigarettes within 30 minutes of waking, otherwise use 2-mg dose Titrate according to withdrawal symptoms and cravings Suggested regimen is one piece every one to two hours for weeks 1 to 6, one piece every two to four hours for weeks 7 to 9, one piece every four to eight hours for weeks 10 to 12; treatment duration is 12 weeks	Jaw pain, hiccups, dyspepsia, hypersalivation, lightheadedness, nausea, vomiting; throat or mouth irritation can be mitigated by reinforcing proper chewing technique	Prescription or OTC May delay weight gain associated with quitting Use with caution in patients with temporomandibular joint arthritis, dentures, or other significant dental work
Nicotine lozenge	2- or 4-mg lozenge (standard size and mini) Maximum = 20 lozenges per day, or five lozenges in six hours	Preload or start on quit date Park between cheek and gums and allow to dissolve slowly (20 to 30 minutes for standard, 10 minutes for mini) Should not be chewed or swallowed; instructions for use are otherwise identical to nicotine gum; treatment duration is 12 weeks	Nausea, hiccups, headache, cough, heartburn, flatulence, insomnia	OTC May delay weight gain associated with quitting
Nicotine nasal spray	10 mg per mL metered spray One dose = one spray in each nostril; one spray delivers 0.5 mg of nicotine Maximum = five doses per hour, or 40 doses per day	Preload or start on quit date Spray once into each nostril (do not sniff, swallow, or inhale while spraying) Wait two to three minutes before blowing nose Use one to two doses per hour and titrate according to withdrawal symptoms and cravings Treatment duration is up to six months	Burning sensation in nose and throat, rhinitis, watery eyes, cough, sneezing, headache	Prescription only Should be avoided in patients with chronic sinusitis, nasal polyps, rhinitis, and severe reactive airway disease
Nicotine oral inhaler	10-mg cartridge; one cartridge delivers 4 mg of inhaled vapor Maximum = 16 cartridges per day	Preload or start on quit date Take short, shallow puffs into the back of the throat (do not inhale into the lungs like an asthma inhaler or cigarette); continue for 20 minutes Avoid food and drink for 15 minutes before and after use Use one cartridge every one to two hours and titrate according to withdrawal symptoms and cravings Treatment duration is up to 12 weeks, followed by gradual taper for six to 12 weeks	Mouth and throat irritation, cough, headache, rhinitis, dyspepsia, hiccups	Prescription Mimics hand-to-mouth action of smoking Less effective at temperatures < 60°F (15.5°C) Should be avoided in patients with bronchospasms