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Page last updated:
25 October 2024
To optimise the results from smoking cessation programmes it is advised that patients access motivational support from specialist services.
Refer all people who smoke to a smoking cessation service for behavioural support and pharmacotherapy. Some local community pharmacies and GP practices may offer a level 2 service. Level 3 services can be accessed via:
NICE NG209: Tobacco: preventing uptake, promoting quitting and treating dependence covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go.
NG209 also includes advice regarding nicotine-containing e-cigarettes and vaping. At the time of writing, these products are not prescribable on the NHS but can be purchased, and may be available from some specialist smoking cessation services.
MHRA Drug Safety Update (November 2023): E-cigarette use or vaping: reminder to remain vigilant for suspected adverse reactions and safety concerns and report them to the Yellow Card scheme:
For training resources refer to the National Centre for Smoking Cessation and Training (NCSCT) standard for training in smoking cessation treatments.
Nicotine dependence may be assessed with the Fagerström Test or the shorter Heaviness of Smoking Index (see here).
Stopping smoking in one go is the best approach, however if someone does not want, or is not ready, to stop smoking in one go, a harm reduction approach (e.g. cutting down before stopping, smoking reduction, or temporarily not smoking) may be appropriate.
Tobacco smoke can induce liver enzymes, affecting drug metabolism. Some medicines may need dose adjustment or monitoring if a person stops or starts smoking.
Monitor people's use of prescribed medicines that are affected by smoking (or stopping smoking) for efficacy and adverse effects. Medicines that are affected include: clozapine, olanzapine, theophylline and warfarin. For more information, refer to the BNF, individual product SmPCs and:
Do not offer cytisine (cytisinicline), varenicline or bupropion to pregnant or breastfeeding women.
Consider NRT at the earliest opportunity in pregnancy and continue to provide it after pregnancy if the woman needs it to prevent a relapse to smoking, including if the pregnancy does not continue.
Advise pregnant women who are using nicotine patches to remove them before going to bed.
To optimise the results from smoking cessation programmes it is advised that patients access motivational support from specialist services.
Refer all people who smoke to a smoking cessation service for behavioural support and pharmacotherapy. Some local community pharmacies and GP practices may offer a level 2 service. Level 3 services can be accessed via:
Most smoking-related health problems are caused by other components in tobacco smoke, not by the nicotine. Any risks from using NRT are much lower than those of smoking. Nicotine levels in NRT are much lower than in tobacco, and the way these products deliver nicotine makes them considerably less addictive than smoking.
Agree a quit date (unless the person is adopting a harm reduction approach) and ensure the person has NRT ready to start the day before the quit date. In most cases NRT may be provided for up to 12 weeks, however there may be circumstances in which an individual would benefit from extended use e.g. pregnant women, people using a harm reduction method, or those who are very close to achieving a quit and whose attempt might be threatened by withdrawal of NRT. Appropriate intervals for prescribing will depend on the individual’s circumstances but are likely to be every two weeks during the first month; this may be extended to 4-weekly supplies for the rest of the quit attempt.
The person may be supported with ongoing NRT and behavioural support by a stop smoking advisor if accessing smoking cessation services.
Alternatives to long-term NRT provision include consideration of nicotine-containing e-cigarettes or vapes. At the time of writing, these products are not prescribable on the NHS but can be purchased, and may be available from some specialist smoking cessation services. Specialist smoking cessation services may be able to provide individual advice and support.
MHRA Drug Safety Update (November 2023): E-cigarette use or vaping: reminder to remain vigilant for suspected adverse reactions and safety concerns and report them to the Yellow Card scheme:
Advise people that use of a combination of short-acting and long-acting NRT alongside behavioural support, are more likely to result in them successfully stopping smoking.
Patches should be applied to dry non-hairy skin. The site of application should be rotated, avoiding the same area for several days.
The 16-hour patches may help avoid vivid dreams and sleep disturbance, which may be associated with the 24-hour patches. They are also the preferred option for pregnant women.
(16-hour transdermal patch)
Dose
Pregnant women who are using nicotine patches should remove them before going to bed; 16-hour patches (above) are therefore preferred for these women.
The 24-hour patches may be more suitable for those who experience cravings within the first 30 minutes of waking.
(24-hour transdermal patch)
Dose
(24-hour transdermal patch)
Dose
Advise people that use of a combination of short-acting and long-acting NRT alongside behavioural support, are more likely to result in them successfully stopping smoking.
Short acting NRT should be used when required (up to the maximum) when the urge to smoke occurs, or to prevent cravings.
(Medicated chewing gum SF)
Dose
(Medicated chewing gum SF)
Dose
(Lozenges SF)
Dose
(Lozenges SF)
Dose
(Lozenges SF)
Dose
(Mini lozenges SF)
Dose
(Sublingual tablets SF)
Dose
(Inhalator for oromucosal use)
Dose
Notes
(Nasal spray solution)
Dose
Notes
(Oromucosal spray)
Dose
Notes
To optimise the results from smoking cessation programmes it is advised that patients access motivational support from specialist services.
Refer all people who smoke to a smoking cessation service for behavioural support and pharmacotherapy. Some local community pharmacies and GP practices may offer a level 2 service. Level 3 services can be accessed via:
Do not offer cytisine (cytisinicline), varenicline or bupropion to pregnant or breastfeeding women
Indications
Dose
Notes
Days of treatment | Recommended cytisine dose | Max daily dose of cytisine |
Day 1 to day 3 | 1 tablet every 2 hours | 6 tablets (9mg) |
Day 4 to day 12 | 1 tablet every 2.5 hours | 5 tablets (7.5mg) |
Day 13 to day 16 | 1 tablet every 3 hours | 4 tablets (6mg) |
Day 17 to day 20 | 1 tablet every 5 hours | 3 tablets (94.5mg) |
Day 21 to day 25 | 1 or 2 tablets per day | 2 tablets (3mg) |
Indications
Dose
Notes
Indications
Dose
Notes