Objective To explore the efficacy and safety of repetitive transcranial magnetic stimulation （rTMS） in reducing tobacco dependence in schizophrenic inpatients. Methods A total of 82 male schizophrenic patients with smoking in the closed psychiatric ward of Wuhan University People's Hospital from October 2018 to May 2019 were enrolled in the randomized， double-blind control study. All patients met the diagnostic criteria for schizophrenia and tobacco dependence. The patients were randomly divided into treatment group （41 cases） and control group （41 cases） by random number table. The treatment group was given high frequency rTMS stimulation （10 Hz， 110% motor threshold）， left prefrontal dorsolateral cortex stimulation， 5 times per week， for 4 weeks of treatment and 8 weeks of observation， while the control group received rTMS pseudo stimulation treatment. The average number of daily smoking before and after treatment， Fagerstrom Test for Nicotine Dependence （FTND）， Tobacco Craving Questionnaire （TCQ） and positive and negative symptoms scale （PANSS） were compared between the two groups to evaluate the efficacy and mental status of the two groups. The incidence of adverse reactions was compared between the two groups to evaluate the safety. Results Among 41 cases， 3 cases fell off in the treatment group and 5 cases in the control group. The reasons of falling off were 4 cases discharged in advance， 2 cases disobedience and 2 cases with relapse of mental symptoms who were not suitable to continue the trial. Finally， there were 38 cases in the treatment group and 36 cases in the control group. There were statistically significant differences between the two groups in the number of daily smoking， the scores of FTND and TCQ self-assessment scale before and after treatment （F value of interaction effect was 61.398， 43.117 and 77.144， respectively， P＜ 0.01）. The number of daily smoking， the scores of FTND and TCQ self-assessment scale after treatment of the treatment group were significantly lower than those of the control group at the 2nd treatment week， the 4th treatment week and the 8th week ［the number of daily smoking at the 2nd treatment week， the 4th treatment week and the 8th week of the treatment group and the control group： （20.37±4.82）， （16.71±4.05） （17.21±4.07） vs. （27.72±7.21）， （27.17±7.11）， （26.06±5.86）； the score of FTND： （5.53±1.13）， （4.21±1.02）， （4.34±0.84） vs. （7.11±1.47）， （7.06±1.43）， （7.06±1.53）； the score of TCQ： （62.74±4.20）， （55.26±4.92）， （54.97±5.03） vs. （68.14±6.57）， （66.94±6.01）， （66.31±5.87）］， with statistical significance （P ＜ 0.01）. There was no significant difference in PANSS score （including total score， positive scale score， negative scale score and general scale score） between the two groups after 4 weeks of treatment （P＞ 0.05）. There were 7 cases （18.4%） of adverse reactions in the treatment group， including 4 cases of headache， 2 cases of insomnia and 1 case of restlessness. There were 4 cases （11.1%） of adverse reactions in the control group， including 2 cases of nausea， 1 case of insomnia and 1 case of restlessness. There was no significant difference in the total incidence of adverse reactions between the two groups （χ2 =0.781， P＞ 0.05）. All the adverse reactions were not treated and self-relieved. Conclusions High frequency rTMS treatment can reduce the amount of daily smoking and the level of tobacco craving in schizophrenic patients， with good safety.