NICE guidance - use of nicotine replacement therapy (NRT) , varenicline and bupropion for smoking cessation

Summary points of the NICE guidance include:

• offer NRT, varenicline or bupropion, as appropriate, to people who are planning to stop smoking
• offer advice, encouragement and support, including referral to the NHS Stop Smoking Service, to help people in their attempt to quit
• NRT, varenicline or bupropion should normally be prescribed as part of an abstinent-contingent treatment, in which the smoker makes a commitment to stop smoking on or before a particular date (target stop date)
  • 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.
    • subsequent prescriptions should be given only to people who have demonstrated, on re-assessment, that their quit attempt is continuing
• explain the risks and benefits of using NRT to young people aged from 12 to 17, pregnant or breastfeeding women, and people who have unstable cardiovascular disorders. To maximise the benefits of NRT, people in these groups should also be strongly encouraged to use behavioural support in their quit attempt
• neither varenicline or bupropion should be offered to young people under 18 nor to pregnant or breastfeeding women
• varenicline or bupropion may be offered to people with unstable cardiovascular disorders, subject to clinical judgement
• if a smoker's attempt to quit is unsuccessful using NRT, varenicline or bupropion, do not offer a repeat prescription within 6 months unless special circumstances have hampered the person's initial attempt to stop smoking, when it may be reasonable to try again sooner
• do not offer NRT, varenicline or bupropion in any combination
• consider offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray) to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past
• NICE state that clinicians should not favour one medication over another

Reference:

• (1) NICE (February 2008). Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. www.nice.org.uk