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Smoking cessation - Management
How do I follow-up adults over 18 years of age who have started treatment to stop smoking?
- For people quitting abruptly supported by drug treatment, review within 2 weeks of their stop date:
- For people who continue to smoke, reassess their readiness to quit. If they demonstrate a continuing attempt to quit:
- Encourage them to quit abruptly. If they can quit abruptly, continue treatment.
- For people who want to quit but are clearly unwilling or unable to quit abruptly, some experts recommend offering nicotine replacement therapy to help them to reduce the amount they smoke before quitting. However the National Institute for Health and Clinical Excellence does not recommend this approach. Instead it states that this strategy should only be used as part of a properly designed and conducted research study of people who have repeatedly tried and failed to quit and those who are adamant that they do not want to quit abruptly. This approach is therefore not recommended as part of routine clinical practice.
- For people with adverse effects from treatment, consider reducing the dose of current treatment, or trying an alternative treatment (or formulation in the case of NRT).
- For people with significant nicotine withdrawal symptoms on treatment, the options include:
- Increasing the dose (up to the maximum licensed dose that is tolerated).
- For people using NRT patches, consider combining with a rapid-release NRT product to relieve breakthrough symptoms.
- Changing formulation of NRT e.g. people who experience withdrawal symptoms first thing in the morning after removing NRT patch at night could consider using a 24-hour patch.
- For people remaining smoke free and managing well, review each month and prescribe further medication.
- For people using NRT to assist a reduction in smoking before quitting, review within 1 month of starting NRT and assess their level of smoking. The goal is to reduce smoking by at least 50% within a month of starting NRT and to have stopped smoking completely within 6 months. Continue NRT for 3 months after stopping completely.
Clarification / Additional information
- The recommended duration of treatment is:
- Nicotine replacement therapy — 12 weeks.
- Varenicline — 12 weeks followed by a further 12 weeks if it is thought necessary to prevent relapse.
- Bupropion — 7–9 weeks.
Basis for recommendation
Basis for recommending continued treatment only if the person demonstrates a continued attempt to stop:
- This is pragmatic advice that is consistent with recommendations made by the National Institute for Health and Clinical Excellence [NICE, 2008].
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