top of page

Quitting smoking

What are the benefits of quitting smoking? Quitting smoking can lower your chances of getting or dying from heart disease, lung disease, kidney failure, infection, or cancer. It can also lower your chances of getting osteoporosis, a condition that makes your bones weak. Plus, quitting smoking can help your skin look younger and reduce the chances that you will have problems with sex.

Quitting smoking will improve your health no matter how old you are, and no matter how long or how much you have smoked.

What should I do if I want to quit smoking? The letters in the word "START" can help you remember the steps to take:

S = Set a quit date.

T = Tell family, friends, and the people around you that you plan to quit.

A = Anticipate or plan ahead for the tough times you'll face while quitting.

R = Remove cigarettes and other tobacco products from your home, car, and work.

T = Talk to your doctor about getting help to quit.

How can my doctor or nurse help? Your doctor or nurse can give you advice on the best way to quit. He or she can also put you in touch with counselors or other people you can call for support. Plus, your doctor or nurse can give you medicines to:

-Reduce your craving for cigarettes

-Reduce the unpleasant symptoms that happen when you stop smoking (called "withdrawal symptoms").


You can also get help from a free phone line (1-800-QUIT-NOW) or go online to

What are the symptoms of withdrawal? The symptoms include:

-Trouble sleeping

-Being irritable, anxious or restless

-Getting frustrated or angry

-Having trouble thinking clearly


Some people who stop smoking become temporarily depressed. Some people need treatment for depression, such as counseling or antidepressant medicines. Depressed people might:

-No longer enjoy or care about doing the things they used to like to do

-Feel sad, down, hopeless, nervous, or cranky most of the day, almost every day

-Lose or gain weight

-Sleep too much or too little

-Feel tired or like they have no energy

-Feel guilty or like they are worth nothing

-Forget things or feel confused

-Move and speak more slowly than usual

-Act restless or have trouble staying still

-Think about death or suicide


If you think you might be depressed, see your doctor or nurse. Only someone trained in mental health can tell for sure if you are depressed.

If you ever feel like you might hurt yourself, go straight to the nearest emergency department. Or you can call for an ambulance (in the US and Canada, dial 9-1-1) or call your doctor or nurse right away and tell them it is an emergency. You can also reach the US National Suicide Prevention Lifeline at 1-800-273-8255 or

How do medicines help you stop smoking? Different medicines work in different ways:

Nicotine replacement therapy eases withdrawal and reduces your body's craving for nicotine, the main drug found in cigarettes. There are different forms of nicotine replacement, including skin patches, lozenges, gum, nasal sprays, and "puffers" or inhalers. Many can be bought without a prescription, while others might require one.


Bupropion is a prescription medicine that reduces your desire to smoke. This medicine is sold under the brand names Zyban and Wellbutrin. It is also available in a generic version, which is cheaper than brand name medicines.

Varenicline (brand names: Chantix, Champix) is a prescription medicine that reduces withdrawal symptoms and cigarette cravings. If you think you'd like to take varenicline and you have a history of depression, anxiety, or heart disease, discuss this with your doctor or nurse before taking the medicine. Varenicline can also increase the effects of alcohol in some people. It's a good idea to limit drinking while you're taking it, at least until you know how it affects you.

How does counseling work? Counseling can happen during formal office visits or just over the phone. A counselor can help you:

Figure out what triggers your smoking and what to do instead

Overcome cravings

Figure out what went wrong when you tried to quit before


What works best? Studies show that people have the best luck at quitting if they take medicines to help them quit and work with a counselor. It might also be helpful to combine nicotine replacement with one of the prescription medicines that help people quit. In some cases, it might even make sense to take bupropion and varenicline together.

What about e-cigarettes? Sometimes people wonder if using electronic cigarettes, or "e-cigarettes," might help them quit smoking. Using e-cigarettes is also called "vaping." Doctors do not recommend e-cigarettes in place of medicines and counseling. That's because e-cigarettes still contain nicotine as well as other substances that might be harmful. I

t's not clear how they can affect a person's health in the long term.

Will I gain weight if I quit? Yes, you might gain a few pounds. But quitting smoking will have a much more positive effect on your health than weighing a few pounds more. Plus, you can help prevent some weight gain by being more active and eating less. Taking the medicine bupropion might help control weight gain.

What else can I do to improve my chances of quitting? You can:

Start exercising.

Stay away from smokers and places that you associate with smoking. If people close to you smoke, ask them to quit with you.

Keep gum, hard candy, or something to put in your mouth handy. If you get a craving for a cigarette, try one of these instead.

Don't give up, even if you start smoking again. It takes most people a few tries before they succeed.


What if I am pregnant and I smoke? If you are pregnant, it's really important for the health of your baby that you quit. Ask your doctor what options you have, and what is safest for your baby.

cigarette smoking is a major cause of disease. More than 400,000 deaths occur each year in the United States as a result of cigarette smoking. In addition, exposure to secondhand smoke is estimated to cause 40,000 deaths each year from heart disease and contributes to other diseases as well. Smoking is a major cause of non-fatal diseases, including osteoporosis, skin wrinkling, peptic ulcer disease, impotence, and pregnancy complications. Even smoking small amounts, such as one cigarette a day, is associated with increased health risks.

Quitting and staying smoke-free can be a challenge, but many smokers have done it. This topic review discusses the benefits of stopping smoking and treatments that can help a smoker to succeed.

BENEFITS OF QUITTING SMOKING: Quitting smoking has large and immediate health benefits for men and women of all ages. The earlier you quit, the greater the benefits. People who quit smoking before age 50 reduce their risk of dying over the next 15 years by one-half, as compared with those who continue to smoke. Quitting smoking is also important to those who do not smoke, since being exposed to secondhand cigarette smoke is responsible for a number of serious health conditions.

Cardiovascular disease  Cigarette smoking doubles the risk of developing coronary heart disease and quitting smoking can rapidly reduce this risk. One year after stopping smoking, the risk of dying from coronary heart disease is reduced by about one-half and continues to decline over time. In some studies, the risk of heart attack was reduced to the rate of nonsmokers within two years of quitting smoking.

Pulmonary disease 


Smoking increases the risk of long-term lung diseases such as chronic obstructive pulmonary disease. While much of the lung damage caused by smoking is not reversible, stopping smoking can reduce further damage to the lungs, and many smokers with a chronic cough and sputum (phlegm coughed up from the lungs) note an improvement in these symptoms during the first year after stopping smoking. 

Asthma and sudden infant death syndrome (SIDS) are more common among children exposed to smoke. Cigarette smoking makes it more difficult to treat asthma.

Cancer - Cigarette smoking is responsible for almost 90 percent of cases of lung cancer. Quitting smoking reduces the risk of lung cancer within five years of stopping, although former smokers still have a higher risk of lung cancer than people who have never smoked. 

Stopping smoking may also reduce the risk of other cancers, such as cancers of the head and neck, esophagus, pancreas, and bladder. Stopping smoking is beneficial even after one of these cancers is diagnosed since it reduces the risk of getting second cancer and may improve the chance of survival from first cancer.


After deciding to quit smoking, the first step is usually to set a quit date. This is the day when you will completely quit smoking. Ideally, this date should be in the next two weeks, although choosing a special date (eg, birthday, anniversary, or holiday) is another option.

Reducing the number of cigarettes smoked prior to the quit date is recommended by some as a means of preparation.

Other steps that may help in preparing to quit include the following:

Talk with a health care provider about ways to quit smoking. Changing behaviors and taking a medication are the two main methods of quitting smoking. You are more likely to quit if you use both methods together.


Think about what happened with your previous quit attempts. What worked? What did not work? What contributed to relapse? What did you learn that you can do differently this time to be more successful?

Tell family, friends, and coworkers about the plan to quit and ask for their support.

Prepare to deal with nicotine withdrawal symptoms, such as cravings for a cigarette. Other withdrawal symptoms are more general and often not recognized as representing nicotine withdrawal. These include anxiety, difficulty sleeping, irritability, difficulty concentrating, restlessness, frustration or anger, and depression. These symptoms are reduced and more tolerable when smokers use a stop-smoking medication. These include over-the-counter medications, like nicotine patches, gum, or lozenges, or prescription medications like varenicline or bupropion. 


Withdrawal symptoms usually become manageable within a few weeks of stopping smoking completely. Symptoms generally peak in the first three days and decrease over the next three to four weeks. Symptoms vary in intensity but are generally stronger in heavier smokers.


Prepare to deal with things that trigger smoking. Examples include having smokers in the household or workplace, stressful situations, and drinking alcohol. A vacation from work may be an easier time to quit. If you live with a smoker, consider asking that person not to smoke in the house or car to help you succeed in becoming smoke-free.

Anticipate episodic cravings for cigarettes, which can be intense, and may occur periodically over a longer timeframe than withdrawal symptoms. Cravings may be brought on by situations associated with smoking, by stress, or by drinking alcohol. These cravings are a common reason for ex-smokers to relapse. It is important to remember that any single craving will go away in a few minutes if you distract yourself by doing something else for a few minutes.

Plan an exercise program and a reasonable diet to minimize weight gain. Weight gain can occur while stopping smoking because people tend to eat more after quitting. Typically, people gain two to five pounds in the first two weeks, followed by an additional four to seven pounds over the next four to five months. The average weight gain is 8 to 10 pounds. The benefits of quitting smoking are much greater than the risk of gaining weight.

BEHAVIORAL CHANGES TO HELP YOU QUIT: You can make changes in your lifestyle behavior to help you quit smoking on your own or you can participate in individual or group sessions. Using lifestyle behavioral changes with a medication increases your chances of success. 

Problem solving/skills training. When preparing to quit, it is important to identify situations or activities that increase your risk of smoking or relapse. After identifying these situations, you may need to develop new coping skills. This may include one or more of the following:


Make lifestyle changes to reduce stress and improve quality of life, such as starting an exercise program or learning relaxation techniques. Vigorous exercise can enhance the ability to stop smoking and avoid relapse and also helps to minimize or avoid weight gain.

Minimize time with smokers and in places where smoking is allowed. People who live with smokers can consider negotiating with them to stop smoking at home or in the car.


Recognize that cravings frequently lead to relapse. Cravings can be prevented to some degree by avoiding situations associated with smoking, by minimizing stress, and by avoiding alcohol. Cravings will subside. Keep oral substitutes (such as sugarless gum, carrots, sunflower seeds, etc) handy for when cravings develop.


Avoid thoughts like "having one cigarette will not hurt"; one cigarette typically leads to many more.

Have as much information as possible about what to expect during a quit attempt and how to cope during this time. These can easily be found online, by calling a smokers' quitline, or by talking with a health care provider or counselor. Support groups can be helpful. Some medical centers have patient resources or learning centers with self-help materials.

Support can be very helpful in quitting smoking and staying off cigarettes. Support can come from family and friends, a health care provider, a counselor, a telephone hotline (in the United States, 1-800-QUIT-NOW), a text messaging program (in the United States, sign up at, or support groups. In addition to getting encouragement, it is important to have someone to discuss any problems that develop while trying to quit, such as weight gain, lack of support from family and friends, or prolonged withdrawal symptoms.

Group counseling ¡ª Group programs are offered by a number of organizations. They typically include lectures, group meeting, a tapering method leading to a "quit day," development of coping skills, and suggestions for preventing relapse. The cost can vary from nothing to several hundred dollars.

Hypnosis and acupuncture Hypnosis and acupuncture are popular stop-smoking methods. Although scientific support for these two methods is weak, some people who have failed with other techniques feel these treatments were helpful.

MEDICATIONS FOR QUITTINGThere are several medications that may help you stop smoking; in the United States, some of these are available without a prescription while others require a prescription. Effective medications include varenicline (brand name: Chantix), a prescription medication; nicotine gum, patch, or lozenge (available over-the-counter); and bupropion (brand names: Zyban, Wellbutrin), a prescription medication. Any of these medications can have side effects.

Nicotine replacement therapy ¡ª Without nicotine, most people develop withdrawal symptoms. These include depression, difficulty falling or staying asleep, irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, and nicotine craving.

Nicotine replacement therapy is designed to reduce the intensity of these symptoms and make the smoker more comfortable when quitting, but it will not prevent symptoms completely.

Nicotine is available in several forms: as a gum or lozenge, patch, nasal spray, or inhaler. All appear similarly effective [2]. However, individual smokers may find one form particularly helpful. Combinations of these therapies (usually a patch plus gum, lozenges, nasal spray, or inhaler) are more effective than use of one form alone.

Examples of combination treatments include a nicotine patch, which may be worn to provide a constant low level of nicotine, and nicotine gum, which may be used as needed for cigarette cravings.

Nicotine replacement therapy is safe, even in people with known heart disease.

Skin patches Nicotine patches deliver nicotine to the blood through a skin patch. Several doses are available. The highest dose patch (21 mg/patch) is usually appropriate for people smoking 10 cigarettes (half a pack) or more daily. Lighter smokers might choose the 14 mg/patch. Patches reduce withdrawal symptoms but do not eliminate them.

The combination of an intensive behavioral program and nicotine patches can double your chances of quitting.

Treatment with nicotine patches is generally recommended at "full dose" for four to six weeks. Some brands of patches include a tapering period of several additional weeks. Longer use of nicotine patches does not generally improve the chance of quitting.

Use of nicotine at night may interfere with sleep, causing vivid dreams. On the other hand, use of nicotine patches at night increases morning blood nicotine levels, which may help prevent difficult early morning withdrawal symptoms. There is a low risk of addiction with nicotine patches.


Nicotine gum contains nicotine that is slowly released with chewing. Gum is available in 2 and 4 mg pieces.

People who smoke 25 cigarettes per day or less can use 2 mg of nicotine gum when needed. Smokers who smoke more than 25 cigarettes per day can use the 4 mg dose; this produces blood levels of nicotine 40 percent lower than smoking. Smokers may use up to 24 pieces of gum per day. Withdrawal symptoms are not prevented by gum use, but the intensity of the symptoms may be reduced. A very small percentage of former smokers become chronic gum users, but using gum long-term is far less risky than smoking.

When used with an intensive behavioral program, nicotine gum can double your chances of quitting. Without a behavioral program, quit rates with gum are usually lower. Gum use is generally recommended for three to six months.

The gum is meant to be chewed differently than regular chewing gum. To be effective, the nicotine must be absorbed through the cheek or gums. If chewed too quickly, the nicotine is instead swallowed, which can cause stomach upset and is not very effective for treating nicotine withdrawal. To be absorbed well, the user chews it just enough to feel the tingling of nicotine being released, then "parks" the gum in the cheek until the tingling goes away. At that point, the user chews it again until the tingling is felt, then parks it in the cheek. This cycle is repeated for 30 minutes, and then the gum is discarded. Gum users should avoid drinking coffee, sodas, or orange juice while chewing the gum or for 15 minutes beforehand, because these fluids make saliva acidic, which limits nicotine absorption.

Lozenges ¡ª Nicotine lozenges slowly release nicotine into the saliva in the mouth. The nicotine works similarly to the gum, as it must be absorbed in the mouth and not swallowed. Because the lozenges do not require chewing, they may be easier for some people to use. They come in 2 and 4 mg doses.

Inhaler The nicotine inhaler is made up of a mouthpiece and a plastic cartridge that contains nicotine. Nicotine is released when you inhale through the device. Most of the nicotine is deposited in the mouth and throat. It does not actually reach the lungs. Therefore, nicotine is absorbed more slowly than it is when inhaling on a cigarette.

Irritation of the mouth or throat is common, particularly in the beginning. People with asthma or chronic cough may not be able to use the inhaler due to throat irritation.

Nicotine inhalers are available only by prescription in the United States, though they are not more risky than the nicotine patch, lozenge, or gum.

You should plan to quit smoking between one and four weeks after starting varenicline. You should continue it for 12 weeks before concluding if it is working; if you successfully quit at 12 weeks, you may continue taking it for an additional 12 weeks. If you have not quit after taking varenicline for 12 weeks, talk to your health care provider about the next step. Options include working harder to make behavioral changes and continuing varenicline or switching to another treatment.

Common side effects of varenicline include nausea and abnormal dreams.

In 2011, the US Food and Drug Administration (FDA) issued an advisory that, in people who already have heart or blood vessel disease, varenicline may increase the risk of acute heart problems. If there is such a risk, it appears to be small, and is likely outweighed by the benefits of quitting smoking.

Bupropion (brand names: Zyban, Wellbutrin) is an antidepressant that can be used to help you stop smoking. It is usually taken once daily for three days, then increased to twice daily starting two weeks before the quit date; it is typically continued for 7 to 12 weeks.

Bupropion is generally well-tolerated, but it may cause dry mouth and difficulty sleeping. The drug should not be used by people who have a seizure disorder or bipolar (manic-depressive) disorder, and it is not recommended for those who have head trauma, anorexia nervosa, or bulimia, or for those who drink alcohol excessively.

RELAPSE: Most smokers make many attempts to quit before they are able to quit completely. Smoking is a "relapsing" condition, and relapse should not be thought of as failures. Each quit should be regarded a victory, and the longer it lasts, the better.

However, if relapse occurs, it is important to understand why so that your next attempt will be more successful. Keep this in mind when attempting to quit for the first time. If you have success for a while, you can learn what helped and what did not and try again. Try to figure out the reasons that led you to start smoking again, and determine if you used the methods (medication, counseling) correctly. Then explore solutions to use next time. Consider trying different methods or combinations of methods.

Most relapses occur in the first week after quitting, when withdrawal symptoms are strongest. Try to mobilize support resources (eg, family, friends) during this critical time. Consider rewards for not smoking; use the money saved on cigarettes for a special treat such as a massage, a movie, a new outfit, or a special dinner.

Later relapses often occur during stressful situations or with social situations that are associated with smoking, often combined with drinking alcohol. Being aware of these high-risk situations may help.

If other problems, such as depression or alcohol or drug dependency, make it more difficult to quit, consider getting professional help from a health care provider or counselor.

OTHER FORMS OF TOBACCO: Tobacco comes in other forms besides cigarettes. People sometimes think that using these forms is better for them than smoking. While the specific risks differ depending on the form, it's important to keep in mind that all forms of tobacco are associated with potentially serious health risks.

Smokeless products are types of tobacco that are not burned. They include chewing tobacco and snuff or "snus" (a powdered form that comes in a small pouch that people put in their mouth). Like cigarettes, smokeless tobacco products are addictive. They also increase your risk of cancer of the mouth and throat.

Cigars and pipes - Smoke from cigars and pipes is generally not inhaled as far into the lungs as cigarette smoke. For this reason, the risk of lung cancer from cigar or pipe smoking is less than for cigarette smoking; however, the risk is still higher than in people who do not use tobacco at all.

Hookahs or "waterpipes" involve heating tobacco to create smoke that passes through a water bowl and is then inhaled. Using a hookah is associated with an increased risk of lung cancer, other lung problems, and even carbon monoxide poisoning.

E-cigarettes ¡ª Electronic cigarettes, also called e-cigarettes, are devices that heat nicotine into a vapor that you breathe in. This vapor has fewer toxins than the smoke you would get from a cigarette, but that doesn't mean that e-cigarettes are toxin-free. In fact, according to the US Food and Drug Administration (FDA), cancer-causing agents have been found in e-cigarettes.

Some e-cigarettes have been shown to reduce the desire to smoke traditional cigarettes, so people sometimes wonder about using them as a quitting smoking aid. Because they are relatively new products, e-cigarettes have not yet been studied enough to know whether they are a safe and effective way to quit smoking or to know how they compare with FDA-approved stop-smoking medications like the nicotine patch or gum. The manufacture of e-cigarettes is not well-regulated, so their constituents vary greatly from product to product. The FDA does regulate the manufacturing of e-cigarettes that contain nicotine.

WHERE DO I START? The following steps are recommended to start the process of quitting smoking:

Talk to your health care provider about the method you plan to use to quit. Behavior changes should usually be combined with one or more medications (eg, varenicline, nicotine replacement therapy, or bupropion).

Pick a date to quit smoking. Tell friends and family about your plan.

Seek support through free telephone quitlines (eg, in the United States, 1-800-QUIT-NOW

Begin making changes in your behavior; avoid situations that lead you to smoke.

Start varenicline (one to four weeks before your quit date) or bupropion (two weeks before your quit date) or start nicotine replacement (on the day you quit).

Deal with withdrawal symptoms as they develop. Consider using nicotine replacement therapy (such as nicotine patch, gum, or lozenge) to help manage withdrawal symptoms. Do not smoke "just one" to get through a rough day. Consult support groups for more tips on coping with withdrawal.

bottom of page