At a glance
- The WHO recommends nicotine replacement, varenicline, bupropion and cytisine for quitting smoking.
- In trials, varenicline and combined nicotine replacement were among the most effective options.
- Availability differs by country; cytisine is not FDA-approved in the United States.
01
The short answer
Four kinds of medicine have good evidence for helping adults stop smoking: nicotine replacement therapy (NRT), varenicline, bupropion and cytisine. The World Health Organization recommended all four in its first clinical guideline on tobacco cessation in July 2024. In the United States and Puerto Rico, the medicines approved by the FDA for this purpose are NRT, bupropion sustained-release and varenicline.
No single medicine is right for everyone. The choice depends on what is available where you live, your other health conditions and medicines, side effects you want to avoid, cost and what you have tried before. This page compares the options so you can discuss them with a clinician or pharmacist; it is not a prescription and does not give doses.
02
How the medicines compare
The comparison below draws on a 2023 Cochrane review that pooled randomised trials measuring whether people were still not smoking at least six months later. Relative results describe how much more likely quitting was than with the comparison; they do not tell you your own chance of success.
| Medicine | Form | What the evidence shows | Points to discuss |
|---|---|---|---|
| Nicotine replacement therapy | Patch, gum, lozenge, inhaler or nasal spray; some plans use two forms together | Recommended by the WHO and FDA-approved. Varenicline worked better than a single form of NRT, but no clear difference was found against two forms combined (low-certainty evidence). | Which forms suit my smoking pattern, and is combining two forms appropriate for me? |
| Varenicline | Tablet | More than doubled the chance of quitting compared with placebo (high certainty), and worked better than bupropion or single-form NRT. | Nausea is the most common side effect. Japan's health ministry advises avoiding driving while taking it because of reports of dizziness and drowsiness. |
| Bupropion | Sustained-release tablet | Recommended by the WHO and FDA-approved. In direct comparisons, people taking varenicline were more likely to quit than those taking bupropion. | Does it fit with my other conditions and medicines? |
| Cytisine | Tablet | About 30% more likely to quit than with placebo (moderate certainty). No clear difference from varenicline in two trials (low certainty). | Is it licensed and available where I live? It is not FDA-approved in the United States. |
The Cochrane review found that people taking varenicline were probably somewhat more likely to report a serious adverse event than people not taking it, while evidence on heart and mental-health events was compatible with both benefit and harm. That balance is one reason the choice belongs in a conversation with someone who knows your history.
03
Medicine works better with support
The WHO guideline states that combining medicine with behavioural support significantly increases quitting success. Support can be individual, group or telephone counselling, and the WHO also lists text-message programmes, apps and internet programmes as additional or self-management tools. The US Preventive Services Task Force describes combined treatment as medicine plus several counselling sessions.
A practical plan usually includes a quit date or a defined reduction plan, a way to handle cravings and triggers, and a follow-up contact in the first weeks. Ask how long the medicine is normally taken, what to do if you slip, and when to review whether it is working. The tobacco-cessation guide on this site covers building that wider plan.
04
Side effects and safety questions
Every option has possible side effects, and they differ. For varenicline, nausea is the most common, usually mild to moderate and fading over time. For cytisine, the Cochrane review found no clear difference in serious adverse events compared with placebo, based on low-certainty evidence. If you notice severe changes in mood, thoughts or behaviour, chest pain, major breathing difficulty or a serious reaction while taking any cessation medicine, seek urgent medical help and tell the person who prescribed it.
Some situations need individual advice before starting. The Task Force found insufficient evidence to assess the benefits and harms of cessation medicines in pregnancy, so behavioural support is the recommended starting point and any medicine is a decision for the clinician caring for the pregnancy. It also found insufficient evidence on e-cigarettes for quitting, and pointed instead to treatments with proven effectiveness and established safety.
05
What is available where you live
Licensing, supply and coverage differ between countries and change over time, so check locally before relying on a particular product. The points below reflect what the official sources said when this page was prepared.
- United States and Puerto Rico: NRT, bupropion sustained-release and varenicline are FDA-approved for adults. Cytisinicline, a cytisine product, is not approved: in June 2026 its maker reported that the FDA had issued a complete response letter about manufacturing and labelling, not efficacy or safety, and it plans to resubmit.
- Japan: according to the health ministry's information site, smoking-cessation clinics prescribe nicotine patches and varenicline, and nicotine gum and patches are sold in pharmacies. That page, last updated in March 2024, said varenicline shipments had been suspended since June 2021 and that clinic treatment with nicotine patches remained covered by national health insurance in the meantime. Ask the clinic about current supply.
- Elsewhere: cytisine is licensed in some countries and not others. Ask a pharmacist or clinician which of the WHO-recommended medicines are available and covered for you.
06
Questions to ask a clinician or pharmacist
Bring a list of your current medicines and health conditions, and what you have tried before. These questions help turn the comparison into a plan that fits you. Write down the answers so you can check them at the next visit.
- Which of these medicines are available and covered for me here?
- Given my health conditions and other medicines, which options suit me, and which should I avoid?
- Should I use one form of nicotine replacement or combine two?
- What side effects should I expect, and which ones mean I should stop and get help?
- How long should I take it, and when will we review progress?
- What counselling, phone or app support can I use alongside the medicine?
Prepare an accurate medicine list
Sources
- WHO releases first-ever clinical treatment guideline for tobacco cessation in adultsWorld Health Organization · 2024Source accessed:
- Nicotine receptor partial agonists for smoking cessationCochrane (Livingstone-Banks and colleagues) · 2023Source accessed:
- Tobacco Smoking Cessation in Adults, Including Pregnant Persons: InterventionsUS Preventive Services Task Force · 2021Source accessed:
- Quit-Smoking MedicationsCenters for Disease Control and Prevention · 2024Source accessed:
- 禁煙補助薬バレニクリンの使い方Ministry of Health, Labour and Welfare (Japan), e-healthnet · 2024Source accessed:
- Achieve Life Sciences Receives Complete Response Letter from FDA for Cytisinicline NDAAchieve Life Sciences (company announcement) · 2026Source accessed:
Revision history
- Initial English, Spanish and Japanese article prepared with automated assistance. The cited sources were checked for the complete article on 2026-10-25T03:09:11Z (UTC). Publication and preparation use the current date; no historical date was assigned. No independent clinical review is recorded.