Medications to Help Stop Vaping Beyond Nicotine Patches and Wellbutrin
Varenicline (Chantix) is the most effective medication option for stopping vaping beyond nicotine patches or Wellbutrin (bupropion), with evidence showing it is more effective than other smoking cessation therapies and has emerging evidence for vaping cessation. 1
First-Line Medication Options
Varenicline (Chantix)
- Mechanism of action: Works as a partial agonist at the α4β2 neuronal nicotine acetylcholine receptor (nAChR), which:
- Partially stimulates the receptor to reduce withdrawal symptoms
- Blocks nicotine binding, reducing satisfaction if you relapse 2
- Dosing regimen:
- Start 1-2 weeks before your target quit date
- Days 1-3: 0.5 mg once daily
- Days 4-7: 0.5 mg twice daily
- Weeks 2-12: 1 mg twice daily (if tolerated) 3
- Efficacy:
Cytisine
- Mechanism: Similar to varenicline, acts as a partial agonist at nicotinic receptors
- Evidence: Moderate-certainty evidence shows cytisine helps more people quit smoking than placebo (RR 1.30) 5
- Availability: Not yet FDA-approved in the US but available in some countries
- Note: Limited data specifically for vaping cessation, but smoking cessation evidence suggests potential benefit 1
Combination Therapies
Combination NRT (Multiple Forms)
- Approach: Using two forms of nicotine replacement therapy simultaneously
- Example: Nicotine patch (long-acting) plus nicotine gum or nasal spray (short-acting)
- Evidence: Combination NRT is more effective than single NRT products for smoking cessation 2, 4
- For vaping: Very low-certainty evidence suggests possible benefit for vaping cessation 1
Varenicline Plus Bupropion
- Best for: Highly dependent nicotine users who don't respond to initial treatment
- Evidence: In highly dependent smokers, combination therapy increased abstinence rates to 71% versus 43.8% with varenicline alone 6
- Side effects: May increase anxiety (7.2% vs 3.1%) and depressive symptoms (3.6% vs 0.8%) compared to varenicline alone 2
Varenicline Plus NRT
- Evidence: Mixed results in clinical trials
- Side effects: Generally similar to varenicline alone except for increased skin reactions with combination therapy (14.4% vs 7.8%) 2
Third-Line Options
Nortriptyline
- Class: Tricyclic antidepressant
- Evidence: Pooled RR of 2.03 for smoking cessation compared to placebo 2
- Limitations: Not FDA-approved for smoking/vaping cessation; benefits as NRT adjunct not clearly established 2
Clonidine
- Class: Antihypertensive agent
- Evidence: Pooled RR of 1.63 for smoking cessation compared to placebo 2
- Limitations: Dose-dependent side effects may counteract benefits 2
Behavioral Support
Text message-based interventions show low-certainty evidence of effectiveness for vaping cessation in youth and young adults (RR 1.32) 1
Important Considerations
Safety Concerns
Varenicline:
Cytisine:
- May have fewer serious adverse events than varenicline 5
Monitoring
- Monitor for neuropsychiatric symptoms with varenicline and bupropion
- For varenicline users with brain metastases or seizure history, use with caution 2
- Consider dose reduction if side effects are problematic
Special Populations
- Dual users (those who both smoke and vape):
- 61% of dual users express interest in varenicline for cessation
- Varenicline users were more likely to achieve abstinence from both smoking and vaping (8.8% vs 0.8%) 7
The evidence specifically for vaping cessation is still emerging, but medications proven effective for smoking cessation are reasonable options given the similar nicotine addiction mechanism. Varenicline currently has the strongest evidence for both smoking cessation and emerging evidence for vaping cessation.