Don't Just Rely on Willpower to Quit Smoking, Get Medication First: The Success Rate of Taking Varenicline Can More Than Double

Nicotine patches and gum are over-the-counter products available at any pharmacy. A full course lasts 8–12 weeks and costs anywhere from a few hundred to over a thousand yuan. Varenicline and bupropion, on the other hand, are prescription-only drugs; you’ll need a prescription from a smoking cessation clinic or a pulmonology department. These costs are roughly offset by the money saved from buying fewer cigarettes during the same period.

Combining 41 randomized trials involving 17,395 people, the smoking cessation success rate of the varenicline group is 2.32 times that of the placebo group (RR 2.32, 95% CI 2.15–2.51, which is the confidence interval; high-certainty evidence). Varenicline is also superior to bupropion (RR 1.36, higher by about 36%) and the use of a single nicotine replacement therapy (RR 1.25, higher by about 25%). Comparison between nicotine replacement therapy and no medication: 133 trials, 64,640 people, success rate is higher by about 55% (RR 1.55, 95% CI 1.49–1.61). Using a patch plus another fast-acting formulation (gum, lozenge) is higher by about 27% than using only one type (RR 1.27, 95% CI 1.17–1.37, 16 trials, 12,169 people, high-certainty evidence). Side effects: compared to placebo, the proportion of people taking varenicline experiencing nausea is about 2.6 times as high (RR 2.61), insomnia is about 37% higher (RR 1.37), and vivid dreams are also more frequent. Reviews state that nausea is the most common, mostly mild to moderate, and generally subsides gradually. The instructions for a type of nicotine patch in the United States state a three-step reduction process: use 21 mg for 6 weeks, then 14 mg for 2 weeks, finally 7 mg for 2 weeks, and then stop.

Livingstone-Banks J, Fanshawe TR, Thomas KH, et al. (2023). Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD006103. https://doi.org/10.1002/14651858.CD006103.pub8（恶心、失眠的相对风险在全文 Results 的 Adverse events 一节）；Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T (2018). Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD000146. https://doi.org/10.1002/14651858.CD000146.pub5；Theodoulou A, Chepkin SC, Ye W, et al. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD013308. https://doi.org/10.1002/14651858.CD013308.pub2；上海市卫生健康委员会 (2021). 选对药物，让戒烟轻松一点：「市场上可见的戒烟药物主要有三种，即尼古丁替代疗法药物、安非他酮、伐尼克兰」，「尼古丁替代疗法药物属于非处方药（OTC），可通过药店柜台购买；而安非他酮、伐尼克兰属于处方药，须到医院戒烟门诊或呼吸内科就诊，凭医师处方经药师调配后才能得到」. https://wsjkw.sh.gov.cn/jtyx/20211119/df50681e01ba49f896d54f771d8176ae.html；Haleon (2025). NICODERM CQ (nicotine) patch, extended release. DailyMed 说明书：「use according to the following 10-week schedule: STEP 1 … 21 mg patch/day … Weeks 1-6 … 14 mg … Weeks 7-8 … 7 mg … Weeks 9-10」. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=93b2d1b9-83c1-40b5-b6af-90c38c8d6cef（贴片减量那一句）

The three types of smoking cessation medications currently being sold in China are those mentioned above, and only nicotine replacement therapy is available over-the-counter. Common reactions to varenicline include nausea, vivid dreams, and poor sleep. Those with a history of psychiatric illness should inform their doctor; this is the author's suggestion. The course of nicotine replacement therapy is generally 8 to 12 weeks; patches should be tapered step-by-step according to the instructions or a doctor's advice before stopping. Medication only addresses the discomfort during those few weeks of withdrawal, not the 'cravings' in specific situations, so it should be used in conjunction with item 4 of this section (set a quit date) and item 5 (go to a smoking cessation clinic).