Patches, gum, hypnosis, apps: most methods to quit smoking don't need a prescription. Yet two medications are prescribed specifically for nicotine dependence, varenicline and bupropion. They're among the most scientifically studied treatments out there, even though most people have never heard of them.
How these two medications work
Varenicline acts directly on the brain's nicotine receptors. It stimulates them a little, which eases the urge to smoke, while also blocking nicotine's effect if the person smokes anyway: the cigarette then feels less rewarding, which helps prevent a full relapse. Bupropion, originally an antidepressant, acts on other brain circuits linked to dependence and eases withdrawal symptoms.
What the major Cochrane reviews show
Cochrane is an organization that reviews medical studies from around the world with a fine-tooth comb. One of its reviews on varenicline finds, with high-certainty evidence, that it helps significantly more smokers quit than bupropion. Another review, on bupropion, confirms that it stays more effective than quitting unaided, though it doesn't outperform standard nicotine replacement therapy (patches, gum).
Effectiveness that climbs even higher in combination
Some evidence, though more limited, suggests taking varenicline and bupropion together could raise the odds of success even further, compared with varenicline alone. As with choosing between patches, gum, or vaping, this kind of decision is best made with a healthcare professional, who can adjust the treatment to fit each person.
Why so unknown, and is it legal in France?
Yes, both medications are entirely legal in France: they're treatments authorized by health authorities, available only on prescription, exactly like any other medication a doctor prescribes. That prescription requirement already explains part of their low profile: people think of them less often than over-the-counter options like patches or gum.
French health authorities (the Haute Autorité de Santé) also reserve them for second-line use, meaning after a first attempt with nicotine replacement has failed, which already narrows down who they're relevant for. But the main reason for this obscurity is probably elsewhere: varenicline (Champix) simply vanished from French pharmacies between 2021 and June 16, 2025, pulled from the market after a cancer-causing impurity was found in certain batches, before returning with an entirely reworked manufacturing process. A large part of the public simply hasn't had the chance to hear about it in recent years.
When it comes to coverage, the two medications aren't treated the same way. Varenicline is reimbursed at 65% by French health insurance, but only as a second-line treatment for heavily dependent smokers (a Fagerström score of 7 or higher). Bupropion, on the other hand, isn't reimbursed at all and stays entirely out of pocket, at roughly 60 to 80 euros a box. A tobacco specialist or GP can assess whether one of them fits a given situation, especially after several failed attempts with other methods, and pair it if needed with behavioural support to boost the odds of success.
