Smoking Cessation

Question 1

Which medications do NICE recommend can be offered to patients to assist in smoking cessation?

Answer 1

• Nicotine replacement therapy (NRT)
• Varenicline
• Bupropion (2nd choice)

Question 2

When should medication be prescribed?

Answer 2

Should normally be prescribed as part of a commitment to stop smoking on or before a particular date (target stop date)

Question 3

How are prescriptions for medications to assist in smoking cessation to be made?

Answer 3

• Prescription of NRT, varenicline or bupropion should be sufficient to last only until 2 weeks after the target stop date.
• Normally, this will be after 2 weeks of NRT therapy, and 3-4 weeks for varenicline and bupropion, to allow for the different methods of administration and mode of action.
• Further prescriptions should be given only to people who have demonstrated that their quit attempt is continuing

Question 4

What happens if you are unsuccessful with the prescribed medication?

Answer 4

If unsuccessful using NRT, varenicline or bupropion, do not offer a repeat prescription within 6 months unless there are special circumstances

Question 5

Can the medications be prescribed together?

Answer 5

Do not offer NRT, varenicline or bupropion in any combination

Question 6

What are some adverse effects of NRT?

Answer 6

• Nausea &vomiting
• Headaches
• Flu-like symptoms

Question 7

What is NRT prescribed with in people who show high level of dependance of nicotine?

Answer 7

Combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray)

Question 8

What is Varenicline?

Answer 8

Nicotinic receptor partial agonist

Question 9

How is Varencline prescribed to patients?

Answer 9

• Should be started 1-2 weeks before the patients target date to stop as behavioral support
• Recommended course of treatment is 12 weeks (but patients should be monitored regularly and treatment only continued if not smoking)

Question 10

What are some side effects of Varenicline?

Answer 10

• Nausea most common adverse effect
• Headache
• Insomnia
• Abnormal dreams
• Caution in patients with a history of depression or self-harm.

Question 11

What are contraindications to Varenicline?

Answer 11

• Pregnancy
• Breast Feeding

Question 12

What is the mechanism of action of Bupropion?

Answer 12

Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

Question 13

How should Bupropion be prescribed?

Answer 13

Should be started 1 to 2 weeks before the patients target date to stop

Question 14

What is the side effect of Bupropion?

Answer 14

Small risk of seizures (1 in 1,000)

Question 15

What are contraindications to the use of Bupropion?

Answer 15

Contraindicated in:

• Epilepsy
• Pregnancy
• Breast feeding
• Having an eating disorder (relative)

Question 16

How are pregnant women investigated for smoking?

Answer 16

• All pregnant women should be tested for smoking using carbon monoxide detectors
• All women who smoke, or have stopped smoking within the last 2 weeks, or those with a CO reading of >=7 ppm should be referred to NHS Stop Smoking Services.

Question 17

What are the interventions for pregnancy smokers?

Answer 17

• First-line interventions in pregnancy should be cognitive behaviour therapy, motivational interviewing or structured self-help and support from NHS Stop Smoking Services
• NRT often used if the above measures failure. There is no evidence that it affects the child’s birthweight. Pregnant women should remove the patches before going to bed