Publication
Encouraging smokers to stop: what you can do
Medications
Both NRT and Zyban ® are effective treatments‚ even with limited support‚ so although the treatment of choice is behavioural support plus medication‚ medication with limited support can also be beneficial and may be more acceptable to many smokers (1).
We only have space in this guide to give brief details of the medications. If you have any doubts or questions about medications that are not covered here‚ we recommend that you consult the full guidelines‚ and/or to contact your local smoking cessation service.
Which product?
One study that compared a nicotine patch with Zyban ® found the latter to be more effective‚ however one study is insufficient evidence to recommend Zyban ® over NRT. The overall effect size for Zyban ® is very similar to that for NRT in comparable studies‚ thus both are considered first-line treatments(1).
If a smoker arrives with a clear preference for one form of medication‚ it can be offered unless it is contraindicated. Otherwise check for contraindications to all the products and offer a choice between the products that are permitted. It should be noted that advice on NRT and pregnant smokers has recently been changed in the British National Formulary Number 46 to reflect the NICE guidance and pregnancy is no longer listed as a contraindication for NRT.
NRT
There are six NRT products and all have similar effectiveness‚ except that the 4mg gum is more effective than 2mg gum in more dependent smokers.
Thus the choice between them is a practical one:
Patch — it is discreet and easiest to use
Gum — it allows good control of nicotine dose
Spray — better for very addicted smokers
Inhalator — good if smoker misses the ritual of smoking
Tablet — discreet and flexible‚ good dose control
Lozenge — discreet and flexible‚ good dose control
There is no scientific basis for disallowing different forms of NRT to be combined and there may be some benefit to combinations. The most common combinations are of an acute dosing form‚ such as the nasal spray or the inhalator‚ with the patch. It is recommended to prescribe NRT for only two weeks in the first instance‚ with a second or subsequent prescription(s) offered only if the smoker demonstrates a continuing quit attempt.
Zyban ®
Zyban ® is the trade name for bupropion hydrochloride sustained-release (SR)‚ which comes as a tablet. It is an anti-depressant although its effect on smoking appears to be unconnected with this. It does not contain nicotine but the way it helps smokers stop is not known. However‚ it is effective and‚ like NRT‚ has been shown in scientific trials to double a smoker’s chance of stopping. There is not enough evidence yet to know if it may be more effective than NRT.
No recommendation can currently be made on when Zyban ® should be preferred over NRT or vice versa‚ other than those for which one of the drugs is contraindicated. It is recommended to prescribe Zyban ® for four weeks and then four weeks. This avoids a potentially large waste of medication and money in quit attempts that do not last beyond a week or two.
Concerns about safety
oncerns have been expressed in the media over the safety of Zyban ® . It has a similar safety profile to modern anti-depressant drugs that are generally considered safe (4). The Summary of Product Characteristics for Zyban ® declares a seizure risk of 1 in 1000 but this can be mitigated by ensuring that patients are carefully screened for pre-disposing factors. Common side-effects are insomnia and dry mouth but these are rarely serious enough for patients to discontinue treatment.