Pharmacotherapy

Medication improves smoking cessation success and reduces withdrawal symptoms. The chart below describes the current FDA approved pharmacotherapies, with information on dosing, side effects, cost, and Medicaid/Medicare coverage.

These medications have not been shown to be effective for treating tobacco dependence in pregnant or breastfeeding smokers, adolescents, light smokers, or smokeless tobacco users.

TREATMENT (Rx) DOSAGE DURATION PRECAUTIONS SIDE EFFECTS AVERAGE COST COVERAGE

Bupropion SR
Zyban®
generic SR

Wellbutrin SR®

Begin treatment
1-2 weeks before
quit date:

•150mg every morning for 3 days, then 150mg twice daily

7-12 weeks, maintenance up to 6 months

 

• History of taking another form of bupropion
• History of using an MAO inhibitor in the past 14 days
• History of seizure
• History of eating disorder
• Observe for serious neuropsychiatric symptoms: changes in behavior, agitation, depressed mood, suicidal ideation and suicidal behavior.

• Insomnia

• Dry mouth

150mg - 1box of 60 tablets:

• brand name: $197-210/month

• generic SR: $97/month

Medicaid,
Medicare Part D*
Zyban® requires a prior authorization; Bupropion SR does not; Wellbutrin SR® is not covered
Varenicline
Chantix®

Begin treatment
1 week before
quit date:

• Days 1-3: 0.5mg tablet every morning

• Days 4-7: 0.5mg tablet twice daily

• Days 8-end of treatment: 1mg tablet twice daily

 3-6 months

• Significant renal impairment
• Patient undergoing dialysis
• Observe for serious neuropsychiatric symptoms: changes in behavior, agitation, depressed mood, suicidal ideation and suicidal behavior.

• May impair ability to drive or operate heavy machinery

• Nausea

• Insomnia

• Abnormal dreams

Approximately $131/month

Medicaid,
Medicare Part D*
Nicotine Inhaler
Nicotrol Inhaler®		 6-16 cartridges/day Up to 6 months • Particular cardiovascular patient groups

• Local irritation of mouth and throat

• Coughing, rhinitis

 1 box of 168 cartridges: $196 Medicaid,
Medicare Part D*
Nicotine Nasal Spray
Nicotrol NS®		 8-40 doses/day 3-6 months

• Particular cardiovascular patient groups

• High dependence potential

 • Nasal irritation $49/bottle Medicaid,
Medicare Part D*
Nicotine Gum
Nicorette®
generic

1-24 cigs/day:
2mg gum (up to 24 pieces/day)

25+ cigs/day:
4mg gum (up to 24 pieces/day)

Up to 12 weeks

 • Particular cardiovascular patient groups

• Mouth soreness

• Dyspepsia

• Hiccups

• Jaw ache

2mg box of 100-170 pieces: $48

4mg box of 100-110 pieces: $63

Medicaid, requires a fiscal order
Nicotine Lozenge
Commit®
generic

Patient smokes 1st cigarette more than 30 min. after waking: 2mg (up to 20 per day)

Patient smokes 2nd cigarette within 30 min. after waking: 4mg (up to 20 per day)

Up to 12 weeks

 • Particular cardiovascular patient groups

• Nausea

• Hiccups

• Heartburn

2mg box of 72 lozenges:
$34

4mg box of 72 lozenges:
$39

 Not covered by Medicaid or Medicare

Nicotine Patch
Nicoderm CQ®
generic

Prescription-only: generic (legend)

(Step down)

• 21mg/24 hours

• 14mg/24 hours

• 7mg/24 hours

• 4 weeks

• then 2 weeks

• then 2 weeks

 •Particular cardiovascular patient groups

• Local skin reaction

• Insomnia

• Vivid dreams

7mg box: $37

14mg box: $47

21mg box : $48

OTC:
Medicaid
Requires a
fiscal order

Prescription-only:
Medicare Part D*

Counseling Coverage is Available:
• NYS Medicaid covers cessation counseling for pregnant and postpartum women, and children/adolescents aged 10-21. For more information, contact (518) 474-5187.

• Medicare Part B covers cessation counseling for people with a disease caused or exacerbated by smoking; and those taking a therapeutic agent whose metabolism or dosing is affected by tobacco use.

5/2010

Click here to download chart in PDF format

 

* Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

* Medicare coverage varies depending on the individual's drug plan.