If you smoke, giving up is probably the greatest single step you can take to improve your health.
Smoking is responsible for one in every five deaths in adults aged over 35 in England, and half of all long-term smokers will die prematurely due to a smoking-related disease.
Giving up smoking increases your chances of living a longer and healthier life. You will start to notice the benefits soon after quitting. For example:
- after one month your skin will be clearer, brighter and more hydrated
- after three to nine months your breathing will have improved, and you will no longer have a cough or wheeze
- after one year your risk of heart attack and heart disease will have fallen to about half that of a smoker
If you want to quit smoking, initially it is a good idea to see your GP. They can provide help and advice about quitting, and refer you to an NHS Stop Smoking support service. These services offer the best support for people who want to give up smoking.
Studies show that you are four times more likely to quit smoking if you do it through the NHS. For more information, call the NHS Stop Smoking helpline on 0800 022 4332 (England only).
Read more about how NHS stop smoking advisers can help you to quit.
Treatment and support from your GP
If you do not want to be referred to an NHS Stop Smoking support service, your GP can still provide treatment advice to help you quit smoking.
Your smoking habits will need to be assessed to get an idea of your level of addiction and to outline the benefits of quitting. This is also a chance to help identify potential triggers, such as living with others who smoke or stress.
Your GP can prescribe a smoking cessation treatment to help you quit. There are several different treatments available. The type prescribed will depend on your personal preference and whether you've used any before.
The different types of smoking cessation treatments, their side effects and the way they will be prescribed are detailed below.
Read more about how your GP can help you to quit smoking.
Nicotine replacement therapy (NRT)
Nicotine is highly addictive, and it is the nicotine in cigarettes that causes people to become addicted to smoking. Nicotine replacement therapy (NRT) works by releasing nicotine steadily into your bloodstream at much lower levels than in a cigarette, without the tar, carbon monoxide and other poisonous chemicals present in tobacco smoke.
This helps control the cravings for a cigarette that occur when your body starts to miss the nicotine from smoking.
Read more about coping with cravings for a cigarette.
NRT is the most common smoking cessation treatment and comes in different forms, including:
- transdermal patches (which stick to your skin), which release nicotine for either 16 hours or 24 hours
- chewing gum available with either 2mg or 4mg of nicotine
- inhalators, which look like plastic cigarettes through which nicotine is inhaled
- tablets and lozenges, which are placed under your tongue
- nasal spray, which passes nicotine through the lining of your nose
NRT can be prescribed by your GP. All forms of NRT can also be bought from a pharmacist over the counter.
There is no evidence that one particular type of NRT is more effective than another. The one you choose is down to personal preference.
When deciding, it helps to think about the type of smoker you are. For example, are you a heavy smoker who needs a cigarette as soon as you wake up, or are you an occasional smoker who only smokes when they are out having a drink, or after a meal?
Some heavy smokers find a 24-hour patch useful, as it helps to relieve the cigarette craving when waking up. Others prefer using an NRT nasal spray, because it is the fastest-acting form of NRT.
Some smokers find it useful to combine NRT products. For example, they wear patches through the day, then use gum or an inhalation to help relieve a sudden craving for a cigarette.
Most courses of NRT last eight to 12 weeks before you gradually reduce the dose and eventually stop. Most people stop using NRT altogether within three months, although heavy smokers may need to use it for longer.
Side effects of NRT include:
- skin irritation when using patches
- irritation of nose, throat or eyes when using a nasal spray
- disturbed sleep, sometimes with vivid dreams
- upset stomach
- dizziness
- headaches
Side effects are usually mild to moderate, but if they become particularly troublesome, contact your GP as your dosage or type of NRT may need to be adjusted.
Also, use of the nasal spray can cause sneezing and watering eyes for a short time after use. For this reason, if you are prescribed an NRT nasal spray, do not use it while driving, or just before driving.
Nicotine replacement therapy and pregnancy
If you are pregnant or breastfeeding and you want to quit smoking, it is best to stop completely and immediately without any treatment.
However, if you feel you cannot stop smoking without help, your GP may recommend you stop smoking completely and use NRT to control your cravings.
Nicotine is not good for your baby, but the greatest risk from smoking is posed by carbon monoxide, which can cause foetal hypoxia (a severe lack of oxygen). So although using NRT is not ideal for your baby, the risks of nicotine are far outweighed by the risks of continuing to smoke.
As with any other patient who wants to stop smoking, the form of NRT prescribed will depend on your personal preference, ease of use and your level of addiction.
Medication
Two medications are currently licensed to help people give up smoking. These are discussed below.
Bupropion
Bupropion was originally designed to treat depression, but it was discovered that it helped people quit smoking. It is not entirely clear why this is the case. Most experts believe it affects parts of the brain involved in addictive behaviour.
Bupropion is prescribed in tablet form, with people taking one to two tablets a day, as directed by their GP.
Take bupropion for 7-14 days before you try to quit smoking as the medication takes this long to reach its maximum effect. A course of treatment usually lasts seven to nine weeks.
Bupropion is not suitable for:
- children and young people under 18
- women who are pregnant or breastfeeding
- people with anorexia or bulimia
- people with a central nervous system tumour
- people with severe cirrhosis of the liver
Bupropion can also increase your risk of having a seizure (fit), so it is not suitable for people who already have a higher-than-average risk of having seizures, such as people:
Bupropion can cause several side effects, including:
- dry mouth
- upset stomach
- insomnia (trouble sleeping)
- headaches
- difficulty concentrating
- dizziness
- drowsiness
Varenicline
Varenicline is currently the only medication specifically designed to help people quit smoking.
It works by preventing nicotine from binding to receptors (parts of your brain that respond to nicotine), which eases cravings and reduces the rewarding and reinforcing effects of smoking.
If you have not stopped smoking completely before starting varenicline, aim to do so within 7-14 days of starting treatment. The recommended duration of varenicline is 12 weeks. If you successfully stop smoking in this time, you may be prescribed another 12 weeks of treatment to ensure you do not start smoking again.
Varenicline is not suitable for:
- children and young people under 18
- women who are pregnant or breastfeeding
- people with epilepsy
- people with advanced kidney disease
Side effects of varenicline include:
- nausea and vomiting
- headaches
- insomnia (trouble sleeping)
- unusual dreams
- increased appetite
- constipation or diarrhoea
- swollen stomach
- slow digestion
- flatulence
- dry mouth
- tiredness
- dizziness
- drowsiness
There have been reports of people experiencing feelings of depression and suicidal thoughts after beginning treatment with varenicline.
While there is no evidence these symptoms are directly linked to the medication, if you do feel depressed or have thoughts of suicide, stop taking varenicline immediately as a precaution, and contact your GP.
