What is nicotine dependence?

Nicotine is the addictive chemical found in tobacco. If you find it difficult to cut down or stop using products containing tobacco such as cigarettes, you may have nicotine dependence (also known as addiction).

Here are some signs that you may be nicotine dependent:

• You smoke within 30 minutes of waking up.
• You smoke 10 or more cigarettes each day.
• 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.

How does nicotine replacement therapy (NRT) work?

Nicotine replacement therapy (NRT) works by releasing nicotine into your bloodstream to minimise or avoid cigarette cravings.

NRT is considered a ‘first-line’ medicine for treating nicotine dependence. This means that it’s a good first option if you want to take medicines to help you quit smoking. If used correctly, NRT can increase your chance of successfully quitting smoking.

NRT comes in many forms, including:

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

Many people use different types of NRT. For example, you might use a daily nicotine patch with a nicotine inhaler or gum. Using different types of NRT is often more effective than using one.

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

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

What types of prescription medicines treat nicotine dependence?

In Australia, there are 2 types of prescription medicines to treat nicotine dependence:

• 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. Bupropion is also effective at helping people quit smoking but is considered less effective than varenicline and just as effective as NRT.

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

How does varenicline help with nicotine dependence?

Varenicline helps by making smoking less enjoyable. It works by attaching to certain pleasure receptors in your brain. If those receptors are occupied, nicotine can’t bind to those same receptors when you smoke, so it doesn’t feel as good. This can lead to you feeling fewer withdrawal symptoms and cravings.

Varenicline is generally recommended for people who smoke at least 10 cigarettes each day. Your doctor can give you more advice about whether varenicline is right for you.

How does bupropion help with nicotine dependence?

Bupropion is an antidepressant medicine that can help people quit smoking. It is not clear how bupropion helps with nicotine dependence. It is thought to act on certain chemicals in the brain to reduce 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 them 1 or 2 weeks before you stop smoking. However, your doctor or pharmacist should advise you on when to start taking them.

Varenicline is taken daily for about 12 weeks. Bupropion is usually taken for at least 7 weeks. Your doctor will review you regularly and monitor your progress.

Most people tolerate both medicines well, but some people have side effects. If you have side effects after starting a new medicine, discuss this with your doctor or pharmacist.

Neither medicine will make you quit smoking alone, but along with a quit plan, support from your doctor and quit smoking services, they can increase your chance of successfully quitting smoking. Depending on your situation, your doctor may recommend that you take a medicine with NRT to increase your chance of quitting smoking successfully.

What are the risks associated with these medicines?

All medicines have side effects, and they are not suitable for everyone. You should read the Consumer Medicine Information (CMI) that comes with the medicine and talk to your doctor or pharmacist if you are concerned about its risk.

Can e-cigarettes (‘vaping’) help with nicotine dependence?

E-cigarettes aren’t recommended if you are trying to quit smoking. This is mostly because there is no strong evidence that e-cigarettes are safe and effective. However, they may be suitable for some people, especially those who want to quit smoking but haven’t succeeded with other methods, including medicines.

If you want to use e-cigarettes as part of your quit plan, speak to your doctor. Vapes containing nicotine are only legal in Australia if you have a prescription from a doctor.

What else can I do to help treat nicotine dependence?

Visit this healthdirect page for more information about nicotine dependence and quitting smoking.

To make a personalised, comprehensive quit plan, visit the Quit website.

When should I see my doctor?

If you want to quit smoking, it’s a good idea to speak to your doctor or pharmacist — especially if you are pregnant of have a chronic health condition. They can assess your situation and help you make a plan to maximise your chances of succeeding.

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