Smoking cessation - bupropion and nicotine replacement therapy

Summary

It is recommended that NRT and bupropion should be available to on prescription for smokers who have said that they want to quit smoking.

NRT or bupropion should normally only be prescribed when the person has made a commitment to stop smoking on or before a certain date (the ‘target stop date’). Healthcare professionals should offer advice and encouragement to help the smoker quit. Ideally, the first prescription of NRT or bupropion should only be enough to last until 2 weeks after the target stop date. Normally, this will be 2 weeks for NRT. For bupropion it will be 3–4 weeks, because bupropion should be taken for about 1 week before the target stop date. The person should only be given a second prescription for NRT or bupropion if they can show that they are still trying to stop smoking.

It is recommended that people who are under the age of 18 years, pregnant or breastfeeding, or who have unstable heart conditions, should discuss the use of NRT with a doctor or nurse before starting treatment.

Bupropion is not recommended for smokers under the age of 18 years, because it is not licensed for use by people in this age group. Women who are pregnant or breastfeeding should not use bupropion.

If the smoker’s attempt to quit is unsuccessful, the healthcare professional should not usually prescribe NRT or bupropion for another attempt within 6 months. However, if external factors interfere with the initial attempt to stop smoking, it may be reasonable to try again sooner. (For example, if a particularly stressful event occurred after the person had started your initial attempt to quit.)

There is currently not enough evidence to recommend the use of NRT and bupropion together.

In deciding which of the available therapies to use and in which order they should be prescribed, doctors should take the following factors into account:

• The smoker’s intention and motivation to quit, and how likely it is they will follow the course of treatment as prescribed.
• Whether counselling and support are available to help the person quit.
• Whether the person has used treatments to attempt to stop smoking in the past. 
• Whether there are medical reasons why the person should not be prescribed NRT or bupropion, and whether they are likely to experience adverse effects with either treatment.
• Which treatment they would prefer to use.

Documents

For healthcare professionals

• TA39 Smoking cessation - bupropion and nicotine replacement therapy: Summary
• TA39 Smoking cessation - bupropion and nicotine replacement therapy: Guidance (html)
• TA39 Smoking cessation - bupropion and nicotine replacement therapy: Guidance

For patients, carers and the public

• TA39 Smoking cessation - bupropion and nicotine replacement therapy: Information for the public

Background information

• Review decision
• Review proposal
• A rapid and systematic review of the clinical and cost effectiveness of bupropion SR and nicotine replacement therapy (NRT) for smoking cessation
• 2002/021 NICE recommends use of smoking cessation therapies

Implementing this guidance

Any further information NICE has produced to help the NHS implement this guideline locally is linked to below:

• None found