How to Quit Smoking or Vaping: The Medications and Strategies That Actually Work

Written by Dr. Casey Dean, DO, Board-Certified Family Medicine Physician | Medically reviewed by Dr. Kathryn Kline, MD | Trinity Family Medicine

If you want to quit smoking or vaping, you are in the majority, and you are far more likely to succeed with a plan than with willpower alone. According to the CDC, about two-thirds of U.S. adults who smoked in 2022 wanted to quit and more than half tried, yet only 8.8% quit that year and fewer than 4 in 10 who tried used counseling or medication. The CDC notes that medication paired with counseling gives you the best chance. With the Great American Smokeout on November 19, 2026, here is what works.

Quick Summary: Key Facts at a Glance

Key takeaway: Quitting is a medical treatment, not a test of willpower — combining medication with counseling or a quitline gives you the best chance of staying quit.

Emergency warning: Call 911 for chest pain or severe shortness of breath. If you have thoughts of harming yourself, call or text 988.

Why Is It So Hard to Quit Smoking or Vaping?

Quitting is hard because nicotine changes brain chemistry, so stopping triggers real withdrawal and strong cravings. Nicotine releases dopamine, a reward chemical, and your brain adapts until you need nicotine just to feel normal. Withdrawal usually peaks in the first few days and eases over several weeks. Vaping can be just as hard to stop, because many devices deliver high nicotine doses and are easy to use all day.

What Happens to Your Body When You Quit?

Your body starts to recover within hours of your last cigarette, and the benefits keep building for years. According to the American Lung Association, citing the Surgeon General, within one year of quitting your extra risk of coronary heart disease drops to about half that of someone who still smokes. After about 15 years, it is similar to that of someone who never smoked.

Lung function improves within months, and stroke and cancer risks fall over time. Quitting can also help erectile dysfunction caused by poor blood flow and slows lung decline in COPD. Quitting at any age helps.

What Is the Most Effective Way to Quit Smoking?

The most effective way to quit smoking is to combine an FDA-approved medication with behavioral support, such as counseling, a quitline, or a text program. The 2021 USPSTF concludes "with high certainty" that this net benefit is substantial for nonpregnant adults.

The FDA has approved seven quit-smoking medications: five forms of nicotine replacement therapy (NRT) plus varenicline and bupropion.

Nicotine Replacement Therapy (NRT)

Nicotine replacement therapy gives you controlled nicotine without the smoke, easing withdrawal. The patch, gum, and lozenge are over the counter; the inhaler and nasal spray need a prescription. Combination NRT — a patch plus gum or a lozenge for breakthrough cravings — works better than one product alone.

Varenicline

Varenicline (formerly sold as Chantix) is a prescription pill that partially stimulates nicotine receptors in the brain, which reduces cravings and makes smoking less rewarding. Per FDA labeling, you typically start it one week before your quit date and take it for 12 weeks, with another 12 weeks if you have quit.

In the EAGLES trial (The Lancet, 2016), 8,144 adults were randomly assigned to varenicline, bupropion, a nicotine patch, or a placebo (a look-alike pill with no medicine). People taking varenicline had about 3.6 times the odds of quitting compared with placebo, and about 1.7 times the odds compared with the patch or bupropion. Odds are not the same as chances, so this does not mean you are 3.6 times as likely to quit.

What this means in plain English: In the largest head-to-head trial, all three medications beat placebo and varenicline helped the most people quit, though none works for everyone.

Bupropion

Bupropion SR (Zyban) is a non-nicotine pill that reduces cravings and withdrawal. It shares its active ingredient with the antidepressant Wellbutrin, so never take both. You start it one to two weeks before your quit date. In EAGLES, it worked about as well as the patch.

How Do Quit-Smoking Medications Compare, and What Are the Side Effects?

Each medication works differently and has its own trade-offs, so your clinician should review your health history before you start:

In December 2016, after EAGLES found no significant increase in serious neuropsychiatric events versus the patch or placebo, the FDA removed the boxed warning (its strongest safety alert) about serious mental health side effects from varenicline. It also removed that quit-smoking language from bupropion's boxed warning, which still carries the standard antidepressant warning about suicidal thoughts. That does not mean mood changes can't happen. Both labels still tell you to stop the medicine and call your clinician right away if you notice new mood changes, agitation, or thoughts of self-harm.

Dr. Dean's clinical perspective: When someone tells me they've "tried everything," my first question is how they used it. A single patch for a couple of weeks, or stopping varenicline at the first wave of nausea, isn't a full trial. Often the next step isn't a brand-new medication but a better plan: the right dose, a fast-acting nicotine product for breakthrough cravings, enough time on treatment, and a follow-up visit before the hardest weeks hit.

Which Quit-Smoking Medication Is Right for You?

For most adults, varenicline plus counseling is the best place to start, but the right choice depends on your health, past attempts, and preferences. This table does not replace a medical visit.

The 2020 ATS guideline strongly recommends varenicline over the patch and bupropion, starting it even before you feel ready to quit, and treatment longer than 12 weeks. It conditionally suggests adding a patch to varenicline.

Doctor's tip: A slip is data, not failure. Most people need several attempts, and each one shows which triggers, doses, or medication combinations to adjust next time.

Not sure which option fits you? A Trinity Family Medicine physician can review your history by telehealth and talk through your choices. Book a visit.

Do E-Cigarettes Help You Quit Smoking?

Nicotine e-cigarettes can help some adults quit cigarettes, but U.S. guidance does not recommend them as a first choice. The November 2025 version of the Cochrane living review (a respected summary of the best available studies) found high-certainty evidence that nicotine e-cigarettes help more people quit than NRT. About 9 in 100 people using them quit for at least six months, compared with about 6 in 100 using NRT.

However, the 2021 USPSTF found insufficient evidence to recommend them, the 2020 ATS guideline suggests varenicline instead, and no e-cigarette is FDA-approved as a quit aid. If you have already switched, the next goal is to stop nicotine completely, not to use both.

How Do You Quit Vaping, and Is There a Medication for It?

Quitting vaping uses the same tools as quitting smoking — a quit date, a craving plan, support, and sometimes medication — though no medication is FDA-approved specifically for vaping.

A 2025 randomized trial in JAMA studied 261 people ages 16 to 25 who vaped. Among those given varenicline plus brief counseling, 51% did not vape at all during weeks 9 to 12, compared with 14% on placebo. By weeks 9 to 24, those rates were 28% versus 7%. Varenicline is not FDA-approved for vaping, so this use is off-label (for a purpose the FDA hasn't specifically approved).

What about cytisinicline? This plant-based medication, studied for both smoking and vaping, is not FDA-approved as of November 2026. In June 2026, the FDA declined to approve it for now, citing manufacturing issues rather than safety or effectiveness; the company plans to resubmit.

Can You Use Quit-Smoking Medications During Pregnancy?

Sometimes, but only with your clinician's guidance: counseling comes first, and nicotine replacement may be an option when benefits outweigh risks. The 2021 USPSTF gives behavioral counseling for pregnant people an "A" grade. It found insufficient evidence to judge the benefits and harms of medication in pregnancy.

The American College of Obstetricians and Gynecologists (ACOG) advises individualized care and notes that quitting at any point in pregnancy helps, with the greatest benefit before 15 weeks. Varenicline has limited pregnancy safety data. If you are pregnant, breastfeeding, or trying to conceive, talk with your clinician before using any quit aid.

Do You Need Testing Before or After You Quit?

Routine lab tests are not usually needed to start a quit plan; your clinician reviews your history, medications, and blood pressure instead.

Quitting is a good time to catch up on screening. The 2021 USPSTF recommends (grade B) a yearly low-dose chest CT scan for lung cancer in adults ages 50 to 80 with a 20 pack-year history (for example, a pack a day for 20 years) who still smoke or quit within the past 15 years. Get checked promptly for a lingering cough, coughing up blood, unexplained weight loss, or worsening shortness of breath — don't blame those on withdrawal.

Anxiety, depression, sleep problems, and thyroid disease can mimic withdrawal. Also, chemicals in cigarette smoke (not nicotine itself) speed up caffeine breakdown, so after you stop smoking, the same coffee can feel stronger.

How Can You Manage Cravings and Weight Gain?

Most cravings pass within a few minutes and any weight gain is usually modest, so a simple plan for both goes a long way:

The health benefits of quitting far outweigh modest weight gain. According to a 2021 Cochrane review, bupropion and NRT may limit weight gain while you take them, though the effect fades after treatment ends.

When Should You See a Doctor to Quit Smoking or Vaping?

See a doctor if you have relapsed after quitting on your own, smoke within 30 minutes of waking, have heart, lung, or mental health conditions, or are pregnant. A clinician can assess your dependence, check interactions, and prescribe medication. People with unstable heart disease or serious psychiatric symptoms may need in-person care first.

What Happens at a Telehealth Visit to Quit Smoking or Vaping?

A telehealth quit-smoking visit is a video appointment where a clinician reviews your nicotine use and health history and builds a quit plan with you. Your clinician will typically:

Trinity Family Medicine sees adults anywhere in Texas; you need to be located in Texas during the visit. You book online and see the same doctor at every follow-up as your plan adjusts. Visits start at $49.99, no insurance required. Book a visit or call 817-932-4022.

Free quit help in Texas: Yes Quit (1-877-YES-QUIT or YesQuit.org) offers free coaching in English and Spanish and, for eligible adults 18 and older, free nicotine patches, gum, or lozenges. The national quitline, 1-800-QUIT-NOW, is also free.

Frequently Asked Questions

The Bottom Line

Nicotine dependence is a treatable medical condition. The strongest evidence supports combining an FDA-approved medication — with varenicline preferred by the ATS for most adults — with counseling or a quitline, and staying on treatment long enough. Most people who quit for good needed more than one attempt, and the right medication and support can substantially improve your odds this time.

Related reading: COPD symptoms and treatment, erectile dysfunction and heart health, anxiety as a medical condition, and depression treatment.

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