NHS Stop Smoking support services
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 can 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 about NHS Stop Smoking support services, call the NHS Stop Smoking helpline on 0800 022 4 332 (England only).
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, support, and advice to help you quit smoking.
At your first appointment, they will ask you about your smoking habits in order to assess your level of addiction, and outline the benefits of quitting. They can also help you to identify any factors that may make quitting difficult for you, such as living with others who smoke, and any stress that you experience in day-to-day life.
Your GP can prescribe a smoking cessation treatment to help you quit. There are several different treatments available from your GP. The type that you are prescribed will depend on your own personal preference, any previous smoking cessation medication that you have taken, and any side effects that they may cause. The different types of smoking cessation treatments, their side effects, and the way in which they will be prescribed are detailed below.
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 you get from tobacco smoke. This helps to control the cravings for a cigarette that occur when your body starts to miss the nicotine that smoking provides.
NRT is the most common smoking cessation treatment and comes in many different forms including those outlined below:
- Transdermal patches (which stick to your skin) and which are available in formulations that release nicotine for either 16 hours or 24 hours.
- Chewing gum that is available with either 2mg or 4mg of nicotine.
- Inhalators which look like a plastic cigarette and through which nicotine is inhaled (breathed in),
- Tablets and lozenges which are placed under your tongue.
- Nasal spray which works by passing nicotine through the lining of your nose.
If your GP prescribes you a form of NRT, it is likely you will need to use it for the recommended duration of between 8-12 weeks, before gradually reducing the dose and eventually stopping. Most people stop using NRT altogether within three months, although heavy smokers may need to use it for longer.
Side effects of nicotine replacement therapy (NRT)
NRT can sometimes cause side effects which may include:
- allergic reactions, such as skin irritation from a patch, or irritation of your nose, throat, or eyes, from nasal spray,
- disturbed sleep with or without vivid dreams,
- upset stomach,
- dizziness, and
- headaches.
Side effects caused by NRT are rarely severe enough to stop the treatment, but if you experience side effects while taking NRT, your GP may alter your dose of nicotine.
Using NRT does not affect driving in general, but the nasal spray can cause sneezing and watering eyes for a short time after use. For this reason, if you are prescribed a NRT nasal spray, you should not use it while driving, or just before driving.
How nicotine replacement therapy (NRT) will be prescribed
If you feel able to, your GP will recommend stopping smoking completely as soon as possible, with the help of NRT. The form of NRT you are prescribed will depend on your personal preference, ease of use, and your level of addiction. For example, if you are a heavy smoker with a high level of addiction, your GP may prescribe an NRT nasal spray because it is the fastest acting form of NRT.
However, if you do not yet feel ready to stop smoking completely, your GP may suggest a method of quitting known as nicotine-assisted reduction to stop. This involves using NRT to progressively reduce the number of cigarettes you smoke, before eventually stopping smoking altogether.
If your GP suggests using nicotine-assisted reduction to stop, you will be prescribed either an NRT gum, or inhalator, to use in between cigarettes. These forms of NRT are best for use between cigarettes because they release a short burst of nicotine, rather than a steady, constant supply. It is necessary to use short-release NRT when you are still smoking because ingesting the nicotine from your cigarettes, combined with that from a steady-release NRT could make you feel very unwell.
For this reason, you must only use your prescribed NRT in between cigarettes to combat cravings. You should also try and prolong your smoke-free intervals for as long as you can, and steadily reduce the number of cigarettes you smoke. By six weeks of NRT treatment, you should aim to have cut down on your usual cigarette consumption by half.
With the advice of your GP, you can stop smoking whenever you feel ready, but this should be no more than six months after the start of your NRT treatment.
Nicotine replacement therapy and pregnancy
If you are pregnant or breast-feeding and you want to quit smoking, it is best for your health, and that of your baby's, if you to stop completely and immediately, without the help of any smoking cessation treatment.
However, if you feel that you cannot stop smoking without help from smoking cessation treatment, your GP may recommend that you stop smoking completely and use NRT to control your cravings. Nicotine is not good for your baby, but the greatest risk to an unborn baby's health from smoking is posed by carbon monoxide which can cause foetal hypoxia (a severe lack of oxygen). Therefore, while using NRT is not ideal in terms of your baby, it is better than continuing to smoke.
As with any other patient who wants to stop smoking, the form of NRT you are prescribed will depend on your personal preference, ease of use, and your level of addiction.
If you feel that you cannot stop smoking completely straight away, your GP may suggest that you use the nicotine-assisted reduction method. You will be prescribed a short-release NRT, such as gum, or an inhalator, to be used in between cigarettes. You must try and prolong your smoke-free intervals for as long as you can, and steadily reduce the number of cigarettes you smoke. In order to protect the health of your unborn baby, try to stop smoking completely as soon as you possibly can.
Bupropion
Bupropion is a medication designed to help smoking cessation. The way in which it works is not completely understood, but it is thought to work on the brain pathways involved in addiction and withdrawal. It is available in the form of tablets.
Bupropion is not suitable for those under the age of 18, women who are pregnant, or breastfeeding, or those who are anorexic, or bulimic. It is also not suitable for those with a central nervous system tumour, or severe cirrhosis of the liver.
With bupropion there is a slightly increased risk of seizures which means that it is not suitable for anyone with an increased risk of having a seizure, such as those who have epilepsy, or bipolar disorder (a condition that adversely affects a person's moods). Bupropion is also not suitable for those who abuse alcohol, or anyone treating diabetes with hypoglycaemic medication, or insulin. The risk of seizures caused by bupropion is related to the amount taken, so it is very important never to exceed your recommended dose.
Side effects of bupropion
Bupropion can cause several side effects which can include:
- dry mouth,
- upset stomach,
- insomnia (trouble sleeping),
- headaches,
- difficulty concentrating,
- dizziness, and
- drowsiness.
As taking bupropion can cause drowsiness, and affect your ability to carry out skilled tasks, you should not drive, or operate machinery, while you are taking it.
How bupropion will be prescribed
If you are prescribed bupropion, you will need to take one tablet a day for the first six days, before increasing the dose to two tablets a day, which should be taken at least eight hours apart. However, you cannot take two tablets a day and should continue taking one tablet a day, if:
- you are over 65 years of age,
- you have mild, to moderate, liver damage, or
- you have kidney damage.
If you have not stopped smoking completely before starting bupropion, you should aim to do so within 7-14 days of starting treatment. You can only take bupropion for a maximum of 7-9 weeks because it is not licensed to be used for any longer than this.
Varenicline
Like bupropion, varenicline is available in tablet form, and is specially designed to help smoking cessation. It works by preventing nicotine from binding to receptors (parts of your brain which respond to nicotine), which eases cravings and reduce the rewarding and reinforcing effects of smoking.
Varenicline is not suitable for those under the age of 18, women who are pregnant, or breastfeeding, or those with epilepsy. It is also not suitable for those who have advanced kidney disease.
Side effects of varenicline
Varenicline can cause side effects which can include:
- nausea and vomiting,
- headaches,
- insomnia (trouble sleeping),
- unusual dreams,
- increased appetite,
- constipation, or diarrhoea,
- swollen stomach,
- slow digestion,
- flatulence,
- dry mouth,
- tiredness,
- dizziness, and
- drowsiness.
As taking varenicline can cause drowsiness and affect your ability to carry out skilled tasks, you should not drive, or operate machinery, while taking varenicline, if it causes you to feel drowsy.
How varenicline will be prescribed
If you are prescribed varenicline you will need to take the following:
- one 0.5mg tablet once a day for days 1-3,
- one 0.5mg tablet twice a day for days 4-7, followed by
- one 1mg tablet twice a day from day eight onwards.
If you have not stopped smoking completely before starting varenicline, you should aim to do so within 7-14 days of starting treatment. The recommended duration of varenicline is 12 weeks. If you are successful in stopping smoking completely in this time, you may be prescribed another 12 weeks of treatment to ensure that you do not start smoking again.
