What is nicotine dependence?

Nicotine is the addictive chemical found in tobacco and most vapes. If you have trouble cutting down or stopping the use of tobacco products like cigarettes or vapes, you may have nicotine dependence (also called addiction).

Here are some signs that you may be nicotine dependent:

• You smoke or vape within 30 minutes of waking up.
• You smoke 10 or more cigarettes each day.
• You find it hard to concentrate if you have not vaped recently.
• You vape or smoke when you are stressed.
• You have cravings and withdrawal symptoms if you try to cut down or quit.

Understanding how dependent you are on nicotine can help you choose the most effective strategy to quit.

What are nicotine-dependence medicines?

Nicotine replacement therapy

Nicotine replacement therapy or NRT is a ‘first-line’ medicine for helping people who want to stop using nicotine. This means that it’s a good first option if you want medicine to help you quit smoking or vaping. If used correctly, NRT can give you a better chance of quitting smoking and vaping.

NRT can include:

• patches (to stick on your skin)
• chewing gum
• lozenges
• mouth sprays
• inhalers

NRT is available over the counter at pharmacies. You do not need a prescription. Nicotine patches are also available on the Pharmaceutical Benefits Scheme (PBS) with a doctor’s prescription.

Prescription medicines

There are 2 types of prescription medicines to treat nicotine dependence. These medicines are only for people aged 18 years or over:

• varenicline
• bupropion

Both medicines are taken as oral tablets. You can only buy them from a pharmacy with a doctor’s prescription. They are not usually taken at the same time.

Varenicline is considered a ‘first-line’ medicine for treating nicotine dependence from smoking cigarettes. Bupropion is also effective at helping people quit smoking. It is less effective than varenicline and just as effective as NRT.

It is currently not clear how well varenicline and bupropion work to help people quit vaping.

Your doctor is the best person to help decide which medicine is most suitable for you.

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How do medicines to treat nicotine dependence work?

Nicotine replacement therapy (NRT)

NRT works by putting nicotine into your bloodstream to reduce or stop cravings for cigarettes and nicotine vaping.

Many people use different types of NRT. For example, you might use a nicotine patch every day along with a nicotine inhaler or gum. Using different types of NRT usually works better than using just one.

Using NRT to quit smoking or vaping is less harmful than smoking and vaping. So it’s worth considering if you are trying to quit. Most people can safely use NRT but check with your doctor or pharmacist before you start.

Varenicline

Varenicline helps by making smoking less enjoyable. It works by sticking to some pleasure receptors in your brain. If those receptors are filled, nicotine can’t bind to them when you smoke, so it doesn’t feel as good. This can help you feel fewer withdrawal symptoms and cravings.

Varenicline is usually recommended for people who smoke at least 10 cigarettes each day. Your doctor can help you decide if varenicline is right for you.

Bupropion

Bupropion is an antidepressant medicine that can help you quit smoking. It is not clear how bupropion helps with nicotine dependence. It is thought to work on some chemicals in the brain to lessen cravings.

How do I take varenicline and bupropion?

Your doctor will advise which medicine is most suitable for you. They are not usually taken at the same time.

It can take a few days for the medicine to start working. So it’s usually recommended to start taking it 1 or 2 weeks before you stop smoking. However, your doctor or pharmacist should advise you on when to start taking it.

Varenicline is taken daily for about 12 weeks.

Bupropion is usually taken for at least 7 weeks.

Your doctor will regularly review and monitor your progress.

Most people handle both medicines well, but some might have side effects. If you have side effects after starting a new medicine, talk to your doctor or pharmacist.

Neither medicine will make you quit smoking by itself. But along with a quit plan, support from your doctor and quit smoking services, you have a better chance of successfully quitting smoking.

Depending on your situation, your doctor might recommend that you take a medicine with NRT to help you quit smoking.

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What are the side effects or risks associated with these medicines?

All medicines have side effects, and they may not be right for everyone.

Nicotine replacement therapy

The side effects of NRT can be different based on how you take it.

The side effects of patches include:

• skin redness
• itch
• trouble sleeping and vivid dreams
• headaches
• weight gain

The side effects of gum, inhalers and lozenges include:

• heartburn
• nausea (feeling sick)
• sore throat

The side effects of mouth sprays include:

• sore throat
• hiccups

Varenicline

Most people don't experience side effects with varenicline but they can happen.

The most common side effects are:

• nausea (feeling sick)
• trouble sleeping
• vivid dreams
• increased appetite and weight gain
• changes in how things taste

If you feel unwell or have changes in your mood or behaviour while taking varenicline, tell your doctor or pharmacist right away.

You need to take care when drinking alcohol while taking varenicline — some people can’t handle as much alcohol.

Bupropion

Bupropion can lead to many different side effects. Some of these include:

• trouble sleeping
• dry mouth
• nausea (feeling sick) or abdominal pain
• vomiting and diarrhoea
• headaches and dizziness
• anxiety
• rash and itch

Serious side effects don’t happen often but they can include seizures.

Call your doctor right away if you are taking bupropion or have just stopped taking it and have signs of:

• depression
• agitation
• thinking about harming yourself
• acting differently than usual

You should read the Consumer Medicine Information (CMI) that comes with medicines. Talk to your doctor or pharmacist if you are worried about its risk.

When should I see my doctor?

If you want to quit smoking or vaping, speak to your doctor or pharmacist first — especially if you are pregnant or have a long term health condition. They can assess your situation and help you make a plan to maximise your chances of succeeding.

You should also speak to your doctor or pharmacist if you are worried about the side effects of the medicines that treat nicotine dependence.

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

Can vapes help with nicotine dependence?

There is limited proof that vapes help you give up smoking in the short- or long-term.

In Australia, the safety of vapes has not been assessed by the Therapeutic Goods Administration (TGA, the Australian Government medicine regulator). Because of this, vapes are not first-line treatments to help you to quit smoking.

There are medicines to treat nicotine dependence that have been assessed and approved by the TGA. These are proven to help you quit smoking and are safer than vapes.

Learn more about what is involved with quitting smoking or vaping.

Resources and support

Quitting support helplines and tools:

• Quitline or Aboriginal Quitline (staffed by Aboriginal and Torres Strait Islander counsellors) on 13 7848 (13 QUIT)
• Download the MyQuitBuddy app
• QuitCoach, online tool

State and territory-based resources:

• Australian Capital Territory - Get help to quit smoking or vaping
• New South Wales - iCanQuit
• Northern Territory - Smoking
• Queensland - Quit HQ
• South Australia - Be smoke free
• Tasmania - Quit Tasmania
• Victoria - Quit Victoria
• Western Australia - Make smoking history

For more information and support:

• Beyond Blue for mental health support on 1300 22 4636.
• Kids Helpline for mental health support for people aged 5-25 years on 1800 551 800.
• Lung Foundation Australia on quitting smoking.
• Department of Health, Disability and Ageing on helping someone to quit.

Languages other than English

• Quit’s website, The Con That Kills is available in several languages via Health Translations Victoria.
• NSW Health's Multicultural Health Communication Service has translated information on quitting smoking.

You can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.