Quit Smoking Medication – Stop Smoking Tablets & Smoking Cessation Pills

"Quitting smoking" is a major challenge for most people. Primarily, certain withdrawal symptoms during nicotine withdrawal make the process much harder, although rigid consumption patterns, misguided coping strategies, and social factors also strongly fuel tobacco use. Prescription quit smoking medications can at least provide support here – as they ease withdrawal symptoms and, in some cases, even double the chances of success.

Which smoking cessation pills are most common, how do they work, and what side effects need to be considered? In this article, we take a closer look at these questions and conclude that medications alone are not the optimal solution. We also examine whether nicotine replacement might sometimes be the better choice, and whether nicotine pouches could offer certain advantages compared to standard nicotine replacement therapy products.

Key Active Substances and Medications for Smoking Cessation

The most important prescription medications approved in Germany to help people stop smoking include:

• Bupropion
• Varenicline
• Cytisine

Common prescription off-label quit smoking drugs include:

• Nortriptyline
• Clonidine

Although they all reduce withdrawal symptoms and nicotine cravings, they follow different mechanisms of action, each with possible side effects and varying success rates.

Bupropion – An Antidepressant as a Smoking Cessation Aid

Bupropion, a stimulating norepinephrine-dopamine reuptake inhibitor (NDRI), belongs to the so-called atypical antidepressants. These are antidepressants that do not fall into classical categories such as SSRIs, tricyclics, tetracyclics, or MAO inhibitors. Although the exact mode of action of this quit smoking medication is not fully understood, there are four well-documented effects that can support smoking cessation:

• Bupropion primarily inhibits the reuptake of dopamine and norepinephrine into the presynapse.
• Additionally, it acts as a dopamine and norepinephrine releaser, increasing their concentration in certain brain areas – including the nucleus accumbens, a central part of the brain’s reward system linked to addiction.
• It also works as a non-competitive antagonist at cholinergic nicotinic receptors.
• The serotonergic system is only minimally affected.

Altogether, this helps counter withdrawal symptoms, stabilize mood, and reduce cravings. The goal of this pharmacological therapy is complete abstinence – smoking is not allowed during treatment.

Efficacy Studies: Quitting Smoking with Bupropion

A 2023 study on smoking cessation with medication showed higher success rates for smokers using Bupropion.*1 According to Stiftung Gesundheitswissen:

"18 out of 100 people who took Bupropion were still smoke-free after 6 and 12 months. [...]"*2

Although 18% may not sound like much, this medication effectively helps manage withdrawal symptoms and nicotine cravings. This suggests that, besides treating withdrawal, other factors strongly contribute to continued smoking.

Therefore, combining pharmacological treatment with additional strategies (especially psychotherapy and lifestyle/social counselling) may achieve even higher success rates.

Nevertheless, compared to no medication at all, success rates improve significantly. Without symptom relief, quitting rates often remain in the single-digit percentage range.*3

Bupropion Side Effects

Unfortunately, treatment with Bupropion also comes with numerous possible side effects. The list is long, with some of the most common being: insomnia, dry mouth, nausea, restlessness, tremor, anxiety, dizziness, seizures, visual disturbances, taste disorders, tinnitus, loss of appetite, blood pressure regulation disorders, hypertension, chest pain, excessive sweating, and skin rash. There are also unfavorable interactions with several other medications that must always be considered.*4

When is Bupropion Treatment Appropriate?

This quit smoking medication is usually prescribed to adult smokers with a high level of nicotine dependence, particularly when nicotine replacement therapy (NRT) or alternative nicotine sources are not desired. As it is a prescription drug, use is only possible after medical consultation.

Bupropion is not used in pregnant or breastfeeding women, adolescents under 18 years, or in patients for whom contraindications exist due to interactions with other medications.

Varenicline – A Nicotinic Receptor Partial Agonist for Smoking Cessation

Varenicline was specifically developed for smoking cessation and is considered one of the most effective medications in this field. It acts as a partial nicotinic acetylcholine receptor agonist at the α4β2 subtype, producing moderate stimulation while blocking externally supplied nicotine from binding.*5

Since this receptor is critically involved in addiction and withdrawal symptoms, Varenicline can both reduce withdrawal effects and block nicotine’s rewarding effects on dopaminergic pathways.*6

In other words: Varenicline reduces both craving and the “reward” of smoking. Smokers who light up while taking this medication experience less satisfaction because nicotine’s action at the receptors is partially blocked.

Efficacy Studies: Quitting Smoking with Varenicline

Because Varenicline not only reduces withdrawal symptoms but also diminishes the pleasure of smoking, success rates are often said to be twice as high compared to non-medicated attempts.*7 To recall the earlier Bupropion study*1, Stiftung Gesundheitswissen states:

"18 out of 100 people who took Bupropion were still smoke-free after 6 and 12 months. Among those who took Varenicline, 24 out of 100 remained smoke-free."*2

This indicates that the efficacy of Varenicline may be even higher than that of Bupropion.*1

Varenicline Side Effects

Unfortunately, this stop smoking tablet can also have multiple side effects. The most common include: nausea, vomiting, diarrhea, constipation, headaches, insomnia, nightmares, abnormal dreams, mood changes, depression, aggressiveness, suicidal thoughts, appetite disorders, taste disturbances, dyspepsia, flatulence, fatigue, drowsiness, dry mouth, and dizziness. Patients with psychiatric conditions appear particularly at risk of worsening mental health issues.*8

It is important to weigh when treatment is beneficial, and side effects should be considered in relation to those of “cold turkey” quitting or other medications. As it is a prescription-only quit smoking medication, proper medical assessment and monitoring—ideally by a specialist—is essential.

When is Varenicline Treatment Appropriate?

Varenicline is an option for smokers with strong nicotine dependence who do not wish to use nicotine replacement products. In Germany, it was previously prescribed on a private basis. From 2025, however, this has changed, making the medication more affordable.*9

It is not suitable for children, adolescents, pregnant or breastfeeding women. Additionally, patients with psychiatric conditions, cardiovascular disease, or lung disease face certain risks*6—so physicians must carefully assess and consider alternative approaches where necessary.

Cytisine – A Plant-Based Active Substance as an Alternative

A relatively new quit smoking medication in Germany is Cytisine – a plant alkaloid produced by various legume species, especially the golden rain tree (Laburnum). While Cytisine has been used as a smoking cessation aid in Eastern European countries for decades, it is considered an "old acquaintance" in this field.*10

The golden rain tree, also known as bean tree, golden chain, or yellow shrub, is a leguminous plant native to Europe and Western Asia. The plant contains cytisine, from which the quit smoking medication Varenicline is thought to have been derived.*11 - © Image: AdobeStock

Similar to Varenicline, Cytisine acts as a partial nicotinic acetylcholine receptor agonist. It binds strongly to the α4β2 subtype of nicotinic acetylcholine receptors, displacing externally supplied nicotine*12 – although its binding strength is somewhat lower than that of Varenicline.*13

Thus, this plant-based substance moderately mimics nicotine’s effects while blocking the rewarding effect of external nicotine. This helps reduce withdrawal symptoms, cravings, and the pleasure of smoking.

Efficacy Studies: Quitting Smoking with Cytisine

According to the Pharmaceutical Journal, two key studies on Cytisine were published in the “New England Journal of Medicine” in 2011 and 2014.*13 In the first placebo-controlled study, efficacy was shown as follows:

"After twelve months, 31 participants in the Cytisine group remained abstinent (8.4 percent), compared to 9 in the placebo group (2.4 percent)."*14

The second was a non-inferiority trial comparing Cytisine with nicotine replacement therapy (patches, gums, lozenges).*13

"After one month, 264 out of 655 participants in the Cytisine group remained abstinent (40 percent), compared to 203 out of 655 in the nicotine replacement group (31 percent). Cytisine was superior to NRT regarding continuous abstinence after one week, two months, and six months."*15

While Cytisine’s effectiveness is proven, Varenicline may be slightly more effective due to its stronger receptor binding at the α4β2 subtype.

In 2024, the German Institute IQWiG noted that due to missing manufacturer data, the benefits of Cytisine (and Bupropion) could not yet be conclusively assessed.*16 In practice, however, experts regard Cytisine as a valuable smoking cessation option, especially when Varenicline is not available or not suitable.

Cytisine Side Effects

The cited studies (2011 and 2014) reported the following common side effects of Cytisine use:

"Very frequent side effects included changes in appetite and weight gain, dizziness, irritability, mood swings, anxiety, sleep disorders, headaches, tachycardia, hypertension, dry mouth, diarrhea, nausea, taste disturbances, heartburn, constipation, vomiting, abdominal pain, rash, muscle pain, and fatigue."*13

Typical mild side effects such as dry mouth, slight discomfort, or altered dream perception also occur frequently but usually disappear after the end of therapy.

When is Cytisine Treatment Appropriate?

In Germany, Cytisine is prescription-only and has been available since 2020. It is an option for smokers wishing to quit who do not want to use nicotine replacement therapy and need an alternative to Varenicline. However, this quit smoking medication should generally not be used in people over 65, under 18, in pregnant or breastfeeding women – and there are other known contraindications. For example, it is not recommended in cardiovascular and vascular diseases, hypertension, certain gastrointestinal disorders, hyperthyroidism, and psychiatric illnesses.*13

As Cytisine has only recently been introduced in Germany, many physicians still have limited experience with it; therefore, consulting a smoking cessation specialist is advisable. It should also be noted that Cytisine products are currently not covered by health insurance and can be difficult to obtain in pharmacies.*9

With increasing demand, availability may improve. Overall, Cytisine represents an interesting herbal smoking cessation pill with a mechanism of action similar to Varenicline.

Other Medications (Nortriptyline, Clonidine) – Reserve Options

Besides approved quit smoking medications, at least two additional off-label drugs are worth mentioning – Nortriptyline and Clonidine. These are sometimes used but do not represent the gold standard. Careful evaluation and medical supervision by an experienced physician are particularly important in these cases.

For completeness, they are briefly mentioned here. Since this is off-label use, the mechanism of action is not described in detail. The antidepressant Nortriptyline and the antihypertensive drug Clonidine are usually prescribed only when first-line methods are ineffective.*9

Nortriptyline for Smoking Cessation

Nortriptyline is an older tricyclic antidepressant. Studies have shown that it can help smokers reduce severe withdrawal symptoms.*17 However, it is considered a second-line quit smoking medication, used only when first-line therapies (NRT, Bupropion, Varenicline) are unsuitable or have failed.*18

Possible side effects include dry mouth, dizziness, weight gain, or circulatory problems, which is why it is rarely used. Nevertheless, clinical guidelines note that Nortriptyline can be effective and may be attempted under medical supervision as an off-label therapy if no contraindications exist.*18

Clonidine for Smoking Cessation

Clonidine is primarily an antihypertensive drug but can also help with withdrawal symptoms (especially restlessness and sweating).*19 However, it is not approved in Germany as a smoking cessation medication. In off-label cases, it is sometimes used when other methods are not tolerated.*20

Who Should (and Should Not) Use Quit Smoking Medications?

Medications can make quitting smoking much easier – but not every smoker needs or tolerates them. Below is an overview of who may benefit and what to consider:

• High dependence: Smokers who light up shortly after waking or consume large numbers of cigarettes daily often have strong physical tobacco dependence. In these cases, spontaneous withdrawal without help is unlikely to succeed. Quit smoking medications can buffer withdrawal symptoms and improve success rates.
• Multiple failed attempts: Smokers who have repeatedly failed to quit may succeed with medical support. Medications do not replace motivation but reduce part of the "fight" against withdrawal. Those who relapse without aids should discuss Bupropion or Varenicline treatment with their doctor.
• Combined support: Medications work best alongside counselling and/or psychotherapy. Smokers willing to work on their habits (e.g., in support groups or therapy) have higher chances of success. Those expecting a "pill instead of willpower" may be disappointed – mindset remains crucial.
• Contraindications: Not everyone should take smoking cessation pills. Pregnant and breastfeeding women should avoid them – here, only nicotine replacement products or psychological support are considered. Adolescents under 18 are usually not prescribed medication. In severe physical illness (e.g., acute heart problems, neurological disorders), the doctor decides individually whether medication is safe. Full medical history and risk assessment are mandatory before treatment.
• Psychiatric comorbidity: Smokers with depression, anxiety, or other psychiatric conditions should quit carefully. Bupropion can be beneficial in depression, and Varenicline may be used in stable patients (e.g., those with stabilized schizophrenia, according to guidelines).*21 However, mood changes must be monitored closely, and medication discontinued if serious psychiatric side effects occur.

Quit smoking medications provide support and a real opportunity – but it is becoming clear that the highest success rates are usually achieved when combined with additional approaches such as psychotherapy and counselling. After all, there is no such thing as a “pill instead of willpower”.

Advantages and Disadvantages of Smoking Cessation Medications

Pharmacological support can make quitting smoking significantly easier. However, it also comes with both pros and cons. The following are the most important advantages and disadvantages of this method:

• Higher success rates: Smoking cessation pills increase the likelihood of becoming permanently smoke-free. Varenicline, for example, doubles the success rate compared to no medication.*7 Bupropion also significantly increases the chances of successful withdrawal.*1,*3 Overall, with medication, more smokers reach their goal of quitting.
• Relief from withdrawal symptoms: These medications act on neurotransmitters or nicotine receptors in the brain, reducing withdrawal symptoms such as restlessness, irritability, and intense cravings. Varenicline, for instance, not only reduces symptoms and cravings but also decreases the pleasure of smoking itself.
• Side effects and risks: Potential side effects must be considered. Serious complications are rare but cannot be completely excluded. A careful medical assessment is always necessary.
• Not suitable for everyone: Quit smoking medications are prescription-only and not appropriate for certain groups of people.
• Costs: Another disadvantage are the costs. For many years, statutory health insurance in Germany did not cover these medications, leaving patients to pay high expenses themselves.*7 Although a change came in 2025 allowing Varenicline and certain NRT products to be reimbursed under evidence-based programs for severe tobacco dependence, Bupropion and Cytisine remain excluded.*9
• Limited availability: Varenicline, for instance, was temporarily unavailable due to production stops, but has been back on the market since April 2025. In general, availability should be checked with a pharmacy, as Cytisine products, for example, are still only partly available.*9

While not exactly a disadvantage, it must also be considered that there are no shortcuts to quitting smoking. In addition to withdrawal symptoms, rigid consumption patterns, misguided coping strategies, and social factors strongly drive tobacco use. These require targeted approaches. This highlights the importance of complementary strategies such as psychotherapy and lifestyle/social counselling. An isolated use of quit smoking medication is rarely the optimal solution without additional support.

A Holistic Approach Considers Bio-Psycho-Social Factors

Anyone who truly wants to quit smoking for good must think holistically. It is not just withdrawal symptoms that fuel continued smoking – psychological and social factors play a major role. The biopsychosocial model aims to take these different levels into account. For more details, see:

© Image: AdobeStock/Богдан Скрипник

Pharmacological treatment should therefore only be seen as one pillar – true long-term success usually comes when combined with other approaches.

Nicotine Pouches as an Alternative to Quit Smoking Medications

Although they have their advantages, the disadvantages of the medications mentioned above should not be overlooked – to recap briefly, these include:

• Side effects and risks
• Not suitable for everyone
• High costs
• Limited availability

If medical quit smoking support is not possible for these reasons – or if someone simply wishes to avoid it – there is always nicotine replacement therapy (NRT) or switching to smokeless alternative nicotine products such as snus and nicotine pouches. Common NRT products include gums, lozenges, patches, inhalers, and nasal sprays.

But even these have not only advantages – although they are effective. Patches are not well tolerated by everyone and can be bothersome; gums, lozenges, sprays, and inhalers may be inconvenient, especially during work; and cost is also an issue, since users usually cover the full price themselves.

As a successful alternative, nicotine pouches and snus are increasingly considered – they remain relatively affordable and, as part of a tobacco harm reduction approach, their public health value is emphasized.

>> Read here which advantages nicotine pouches have compared to other NRT products.

That snus and nicotine pouches as a cigarette alternative are effective is increasingly recognized by experts. Recently, a German addiction researcher even supported EU-wide legalization of Swedish snus.

Particularly interesting is a special form of nicotine pouch with so-called Nicotine Polacrilex. Its release profile has been optimized to provide slow, long-lasting, and steady nicotine delivery – effectively counteracting cravings and withdrawal symptoms.

Here you can find suitable products:

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Sources (links last accessed on 26.08.25):

*1 Livingstone-Banks J, Fanshawe TR, Thomas KH, Theodoulou A, Hajizadeh A, Hartman L, Lindson N. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2023 May 5;5(5):CD006103. doi: 10.1002/14651858.CD006103.pub8. (https://pubmed.ncbi.nlm.nih.gov/37142273/)
*2 https://www.stiftung-gesundheitswissen.de/rauchen/was-hilft-besser-bei-der-rauchentwoehnung-vareniclin-oder-bupropion
*3 https://www.barmer.de/gesundheit-verstehen/psyche/sucht/programme-rauchentwoehnung-1058292
*4 https://flexikon.doccheck.com/de/Bupropion
*5 https://gpnotebook.com/de/pages/padiatrie/vareniclin
*6 https://flexikon.doccheck.com/de/Vareniclin
*7 https://www.tk.de/techniker/krankheit-und-behandlungen/erkrankungen/behandlungen-und-medizin/sucht/rauchen/rauchenentwoehnung-medikamentoese-hilfe-2015698
*8 http://flexikon.doccheck.com/de/Vareniclin
*9 https://herzstiftung.de/ihre-herzgesundheit/gesund-bleiben/rauchen-aufhoeren/medikamente
*10 https://www.pharmazeutische-zeitung.de/cytisin-zur-raucherentwoehnung-122794/seite/alle/
*11 https://flexikon.doccheck.com/de/Goldregen
*12 https://flexikon.doccheck.com/de/Cytisin ; see also: https://www.pharmazeutische-zeitung.de/cytisin-zur-raucherentwoehnung-122794/seite/alle/
*13 https://www.pharmazeutische-zeitung.de/cytisin-zur-raucherentwoehnung-122794/seite/alle/ 
*14 https://www.pharmazeutische-zeitung.de/cytisin-zur-raucherentwoehnung-122794/seite/alle/ ; for the study see also: https://pubmed.ncbi.nlm.nih.gov/21991893/
*15 https://www.pharmazeutische-zeitung.de/cytisin-zur-raucherentwoehnung-122794/seite/alle/ ; for the study see also: https://pubmed.ncbi.nlm.nih.gov/25517706/
*16 https://www.iqwig.de/presse/pressemitteilungen/pressemitteilungen-detailseite_109120.html
*17 https://www.pharmazeutische-zeitung.de/pharm7-03-1999/
*18 https://www.cochrane.org/de/evidence/CD000058_does-clonidine-help-smokers-quit
*19 https://www.cochrane.org/de/evidence/CD000058_does-clonidine-help-smokers-quit
*20 https://www.doccheck.com/de/detail/articles/36799-rauchstopp-so-klappts-dieses-jahr
*21 https://register.awmf.org/assets/guidelines/076-006k_S3_Rauchen-_Tabakabhaengigkeit-Screening-Diagnostik-Behandlung_2021-03.pdf