Quitting smoking: the latest evidence about what works

We answer some questions you may have if you’re trying to quit smoking – based on the latest trustworthy evidence from Cochrane.

You can scroll through this page or click on the links below to jump to a particular section:

• Nicotine Replacement Therapy (NRT) 
• Electronic cigarettes (e-cigarettes; or ‘vaping’)
• Varenicline and cytisine
• Bupropion (an antidepressant)
• Behavioural support
• Stopping smoking suddenly or cutting down first? 
• I’ve managed to quit smoking. How can I keep it that way?
• Preventing weight gain after quitting smoking
• Is there anything else I can try to help me quit? Here we list things that may help; things that are unlikely to help; and things we’re unsure about because the evidence is uncertain
• Further information and support

 

1

Nicotine Replacement Therapy (NRT) – patches, gum and lozenges

What is Nicotine Replacement Therapy (NRT)?

NRT is a medicine that is available as skin patches, chewing gum, sprays that go up your nose or in your mouth, inhalers, lozenges and tablets that deliver nicotine to the brain. NRT aims to replace the nicotine that people who smoke usually get from cigarettes, so your urge to smoke is reduced and you can stop smoking. 

Can Nicotine Replacement Therapy (NRT) improve my chances of quitting smoking?

Yes. Any form of NRT increases your chance of quitting smoking compared with placebo.

Is one type of NRT more effective than another?

No. People who smoke have the same chances of quitting successfully whether they use a nicotine patch to quit or another type of NRT, such as gum, lozenges or nasal spray.

Is using more than one NRT product better than using one?

Yes. You’re more likely to successfully quit smoking if you use a nicotine patch together with another, fast-acting type of NRT (such as lozenges, gum or spray). 

What is the best length of time to use NRT?

More research is needed to answer this question.

Is it best to use NRT on a schedule or when I crave it?

More research is needed to answer this question.

Is NRT safe? 

Many studies on NRT have not reported on its safety. Where studies have looked at safety, very few people have reported negative effects. There is not enough information to know whether different types of NRT are more likely to lead to side effects than others.

Side effects of NRT may be rare, but what kind of side effects are there?

Side effects seem to be related to the type of NRT product you use. For example, patches may cause skin irritation whereas gum or tablets may irritate the inside of your mouth. Palpitations and chest pain seem to be rare.

2

Electronic cigarettes (e-cigarettes; or ‘vaping’)

What are electronic cigarettes?

Electronic cigarettes (e-cigarettes) or ‘vapes’ are handheld devices that let you inhale nicotine in a vapour instead of smoke. E-cigarettes do not expose you to the same levels of harmful chemicals as conventional cigarettes because they do not burn tobacco. Using an e-cigarette is often known as ‘vaping’. People can also buy e-cigarettes that do not contain nicotine. 

How do e-cigarettes compare with other ways of trying to quit smoking?

Of the stop-smoking aids currently available in the UK, nicotine e-cigarettes are most likely to help people quit smoking long-term, followed by using two types of nicotine replacement therapy at once (nicotine patch plus another type, such as gum or lozenges). 

Nicotine e-cigarettes or nicotine-free e-cigarettes: how do they compare? 

You are probably more likely to quit smoking using e-cigarettes that contain nicotine compared to ones without nicotine. 

What kind of side effects can vaping have?

E-cigarettes (with or without nicotine) can have unwanted effects. Throat or mouth irritation, headache, cough and feeling sick are the most commonly reported side effects. These effects seem to reduce over time as people continue using e-cigarettes. Evidence suggests that very few people experience serious harms. However, because vaping is quite new we do not know much about possible long-term unwanted effects. 

 

3

Varenicline and cytisine 

What are varenicline and cytisine? 

Varenicline is a stop-smoking medicine and cytisine is a similar, cheaper, medication. They work by activating the nicotinic receptors in the brain (which are usually activated by nicotine to release dopamine) and prevent nicotine from further activating these receptors. This seems to relieve withdrawal symptoms and reduce the ‘rewarding’ effects of smoking. 

Can varenicline or cytisine improve my chances of quitting smoking and how do they compare with other stop-smoking aids?

Alongside e-cigarettes, varenicline and cytisine are the most effective stop-smoking aids for helping people quit long-term. 

What kind of unwanted effects can varenicline or cytisine have?

The most common unwanted effect of varenicline is nausea, but this is mostly at mild or moderate levels and usually clears over time. Varenicline or cytisine may cause other unwanted effects such as stomach problems, difficulties sleeping, and headaches. Serious harms may be rare.

Can I get varenicline or cytisine in the UK?

You may have been prescribed varenicline in the past. However, varenicline is not currently available in the UK or Europe. It has been withdrawn as a precaution, because of an impurity found in the medicine and it is unclear when it will become available again. Cytisine is also currently not available in the UK, but may be in the future. 

 

4

Bupropion (an antidepressant)

What is bupropion?

Bupropion is a type of medicine used to treat depression (antidepressant) which has also been tested as a possible treatment to help people quit smoking. It is sometimes prescribed on the NHS for this purpose.

Can bupropion improve my chances of quitting smoking?

Yes. Using bupropion increases your chance of quitting smoking compared with placebo or no treatment. 

How does bupropion compare with other ways of quitting smoking?

Bupropion may be less effective than e-cigarettes or a combination of NRT products (a nicotine patch plus another form, such as nicotine gum) for quitting smoking.  

Are my chances of quitting smoking better if I use bupropion AND nicotine replacement therapy (NRT)?

There is no reliable evidence to say whether you have a better chance of quitting smoking if you combine bupropion and NRT, compared with just using NRT. 

What kind of unwanted effects can bupropion have?

Bupropion may increase of risk of unwanted effects, particularly those relating to mental health such as anxiety and insomnia. This can lead some people to stop taking the medicine. It is also possible that bupropion causes a slight increase in the risk of serious unwanted effects (including hospitalisation, disability, or death) – but it’s also possible that bupropion makes little or no difference to this risk. 

If I have depression, or a history of depression, might bupropion be more likely to help me quit smoking?

There is not enough reliable evidence to say whether bupropion has a particular benefit for people with current or previous depression.

What does the evidence say about any other antidepressants for quitting smoking?

There is a lack of information about other antidepressants for quitting smoking. However, it seems that selective serotonin reuptake inhibitors (SSRIs) may be of little to no benefit. 

 

5

Behavioural support for quitting smoking

What is behavioural support?

Types of behavioural support can include: advice and counselling on ways to make it easier to quit; information about why or how to stop; or both. Such support may be given in group sessions or one-to-one. Some people may choose to use behavioural support instead of – or as well as – using NRT or other medicines to help them quit. 

Can behavioural support help me stop smoking?

Yes. Behavioural support can help you stop smoking for six months or longer.

What types of behavioural support could be most helpful?

Evidence of benefit is strongest for any form of counselling, and where people are given money for successfully stopping smoking (for example, ​​as part of schemes run in workplaces or clinics). Behavioural support by text message probably helps; tailoring support to the individual or group probably slightly helps; as does support focused on how to quit. 

 

6

Stopping smoking suddenly or cutting down first? 

Am I better off cutting down my cigarettes before quitting, or stopping all at once?

One approach does not seem to be better than the other: you’re probably equally likely to quit whether you stop smoking all at once, or cut down the amount you smoke first. 

Is there anything that can help me cut down?

If you cut down your smoking while using a fast-acting form of nicotine replacement therapy (NRT), such as gum or lozenges, you may be more likely to quit smoking than if you don’t use NRT to help you cut down. It may also help to get face-to-face support while cutting down, compared with just getting self-help materials to try and cut down by yourself. 

 

7

Staying smoke-free after quitting

I’ve managed to quit smoking – and want to keep it that way. Can behavioural support help me stay smoke-free?

Behavioural support aims to help people avoid smoking again by teaching them skills to cope with temptations to smoke. However, it probably has little to no benefit in helping people stay smoke-free after quitting. 

Can taking stop-smoking medication for longer than is typically prescribed help me stay smoke-free? 

There is not enough reliable evidence to say whether taking certain stop-smoking medications for longer than usual can help people stay smoke-free. However, taking NRT for longer may make little to no difference, and taking bupropion for longer probably makes little to no difference. 

Am I more likely to quit smoking if I get help or advice about how to take stop-smoking medicines properly?

Getting help to take your stop-smoking medicine properly may give you a slightly better chance of quitting. For example, this could be telephone or face-to-face support to get additional information about stop-smoking medicines, or support to overcome problems you may have with taking your medicine.

 

8

Preventing weight gain after quitting smoking

What is the best way to avoid putting on weight after stopping smoking? 

Unfortunately, it’s uncertain which programmes or treatments work best to help people avoid gaining weight in the long term (up to 12 months) when stopping smoking, or how they affect success in quitting. 

Is there anything that can help me reduce weight gain after I’ve quit smoking?

Compared with doing nothing: 

• taking part in an exercise programme may help reduce weight gain;
• using Nicotine Replacement Therapy (NRT) probably slightly helps reduce weight gain; 
• taking part in a personalised weight-management programme may also help.

Is there anything that is unlikely to help me reduce weight gain?

• Weight-management programmes without personalized assessment, planning and feedback may have little to no benefit in reducing weight gain. 
• Acceptance-based programmes for weight may also make little to no difference to weight gain.

 

9

Is there anything else I can try to help me quit smoking?

Below is a list of other methods or tools for quitting smoking. They are grouped by those:

• that may help; 
• that are unlikely to help; 
• where the evidence is uncertain, and we can’t be sure whether or not they’re helpful. 

 

Things that may help you quit smoking:

Getting additional behavioural support, alongside stop-smoking medicines:

Getting (additional) behavioural support when you’re also using stop-smoking medicines (such as NRT) can increase your chance of quitting. This is true when comparing more versus less support and when comparing behavioural support to no support.

Printed self-help materials

When no other support is available, printed self-help materials (particularly those tailored to you, personally) may increase your chance of quitting smoking, compared with getting no help at all. However, if you’re already receiving support or taking stop-smoking medication, using printed self-help materials as well may be of little to no extra benefit. 

Telephone counselling 

Calling helplines, or signing up to get calls from counsellors or healthcare providers (for advice, help and information about quitting smoking), probably increases your chance of quitting. For those who sign up to get calls, more calls (three to five) may be better than just one call. 

Mobile phone (text/apps):

“Text messaging programmes may be effective in supporting people to quit, compared to minimal support or as an addition to other forms of stop-smoking support”. However, there is not enough evidence about smartphone apps.

 

Things that may be unlikely to help you quit smoking:

Interventions to enhance one-to-one support provided by partners, family members, or ‘buddies’

Interventions that aim to enhance partner support may have little to no benefit in helping people quit smoking long-term. (This isn’t to say that having support from others is not helpful, but rather that the interventions studied may not have resulted in others being more supportive).

Hypnotherapy

“There is no clear evidence that hypnotherapy is better than other approaches (such as behavioural support or unassisted quitting) in helping people to stop smoking. If a benefit does exist, current evidence suggests the benefit is small at most.” There is very little evidence on whether hypnotherapy causes unwanted effects, although existing data show no evidence that it does.

 

Where the evidence is uncertain, and we can’t be sure whether the intervention is helpful or not:

Motivational interviewing 

Motivational interviewing is a type of counselling that aims to help you explore why you may be unsure about quitting smoking and find ways to make you feel more willing and able to quit. However, we don’t have enough reliable evidence to say whether it can increase your chance of quitting smoking. 

Mindfulness-based treatments:

“​​There is currently no clear evidence that mindfulness-based treatments help people to stop smoking or improve their mental health and well-being”. However, the evidence is low or very low certainty. 

Exercise:

“It could be that exercise may not help at all, or it could be that supporting people to do exercise modestly increases quit rates. We do not know which of these is true.”

Video counselling:

“It is unclear how video counselling compares with telephone counselling in terms of helping people to quit smoking.” 

 

9

Further information and support to help you quit smoking

• NHS Better Health Quit Smoking
• Read more about the health benefits of quitting smoking on the NHS website
• Read more Evidently Cochrane blogs about quitting smoking, including what helps women to quit smoking while pregnant?

 

References (pdf)

With thanks to Jamie Hartmann-Boyce and Nicola Lindson for their comments.

Sarah and Selena have nothing to disclose.

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