Smoking Cessation

Use One Of:

Nicotine Replacement Therapy

or

Varenicline

or

Bupropion

Plan the use which should end two weeks after the quit date. 

Never in prescribe these in combination

If they’re unsuccessful at quitting – don’t represcribe for 6 months

Nicotine Replacement Therapy

  • Use a combination of patches and another vector (inhaler/nasal spray/gum/lozenge)
  • Start as soon as they give up
  • Adverse effects include nausea, headaches and flu-like symptoms

Varenicline

  • A nicotine receptor partial antagonist
  • Start a week before the target quit date
  • It’s a 12 week course – but only give them enough for 2 weeks to start with and then review – if they’re continuing not to smoke then crack on but continue to monitor
  • Studies show it’s more effective than Bupropion
  • Be careful in patients with depression or self harm
  • Common side effects are nausea, insomnia, headaches, weird dreams
  • Don’t use it in pregnancy or breast feeding

Bupropion

  • It’s 3 things: noradrenaline and dopamine reuptake inhibitor and a nicotinic antagonist
  • Use it 1 – 2 weeks before patient intends to quit
  • Small risk of seizures
  • Avoid use in eating disorders
  • Don’t use in pregnancy or breast feeding

Pregnant Smokers

NICE says that all pregnant women should have carbon monoxide measurement as they find it difficult to admit to smoking as pressure to give up  is so great

First Line Is:

  • CBT
  • motivational interviewing
  • Structured self help and support from NHS Stop Smoking Services

If those fail – NRT can be tried – reports are mixed as to whether it works or not. Theres no evidence to show that it effects baby’s birthweight

If using NRT – must remove the patch at night

Varenicline and Bupropion are contraindicated