NICE 2002/021
Issued: Thursday 11th April 2002

PRESS RELEASE

NICE recommends use of smoking cessation therapies

The National Institute for Clinical Excellence have recommended the use of bupropion (Zyban) and nicotine replacement therapy (NRT) for smokers who wish to quit.

The guidance states that NRT or bupropion should normally only be prescribed when smokers have made a commitment to stop smoking on or before a certain date (‘target stop date'), in conjunction with advice and encouragement to help them quit.

First prescriptions 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. Smokers should only be given a second prescription for NRT or bupropion if they can show they are still trying to stop smoking.

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 smokers 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.

  • Whether the smoker has used treatments to attempt to stop smoking in the past.

  • Whether there are medical reasons why the smoker should not be prescribed NRT or bupropion, and whether they are likely to experience adverse effects with either treatment.

  • Which treatment the smoker would prefer to use.

    Anne-Toni Rodgers, Communications Director at NICE, said, “On average 300 people a day die as a result of smoking and each year the NHS spends about £1.5 billion treating smoking related illnesses. Today's guidance means that the NHS will be supporting smokers who are motivated to quit with a choice of clinically and cost effective treatments. The guidance also makes it clear that smokers have to be really committed to quitting and taking up the support and advice on offer and if they are unsuccessful, another course of treatment should not usually be prescribed within 6 months. Doctors, in discussion with the patient, will decide which treatment will be the most appropriate to prescribe."

    Ends

    Notes for Editors

    Smoking

    1. In 1997, in the UK there were more than 11 million regular tobacco smokers - this represents about 27 people in every 100. The numbers of men and women who smoke are about the same. Over the past 5 years, the number of smokers has stabilised or may even be going up, as about 25 out of every 100 15 year olds are regular smokers.

    2. It is estimated that about 4 million smokers a year attempt to quit but that only 3 to 6 out 100 of these succeed.

    3. Half of all smokers die early because of a smoking-related illness. This represents about 120,000 deaths each year. Smoking causes lung cancer, heart disease, and lung diseases such as chronic obstructive pulmonary disease, including bronchitis and emphysema. It costs the NHS about £1500 million (£1.5 billion) a year to treat patients who have a smoking-related disease.

    Nicotine replacement therapy (NRT)

    4. NRT aims to replace the nicotine a smoker gets from cigarettes in other ways, for example through nicotine-containing patches, chewing-gum, lozenges, tablets, inhalators or nasal spray. NRT provides a small amount of nicotine that reduces craving and withdrawal. There are several NRT products currently licensed in the UK. Including ….

    5. NRT products are available either ‘over-the-counter' from the chemist or on prescription through the NHS. They are available to smokers aged over 18 years of age, and to smokers under 18 years on the recommendation of a healthcare professional. People with conditions such as heart disease, over active thyroid, diabetes, severe kidney or liver disease and stomach ulcers are advised to use NRT only after they have carefully considered the risks and benefits of the treatment and after discussion with a healthcare professional. Similar advice applies to women who are pregnant or breastfeeding.

    Bupropion (Zyban)

    6. Bupropion is only available on prescription. Bupropion affects some of the chemical messages in the brain and it is thought to work on the parts of the brain involved in addiction and withdrawal.

    7. Smokers aged over 18 years should take one 150 mg tablet for the first 6 days, followed by two tablets every day for the following 6 to 8 weeks. They should not stop smoking until 7 to 8 days after starting treatment, because the drug needs this time to be working at its best.

    8. The most important side effects associated with bupropion are seizures (fits), which occur in about 1 in 1000 patients. Bupropion must not be prescribed for smokers who have a current seizure disorder (for example epilepsy) or any history of seizure. Smokers who are at risk of seizures must not be prescribed bupropion unless the benefits of smoking cessation are likely to outweigh the risks of taking the drug. There are other factors that may increase the risk of seizures in people taking bupropion, including taking other drugs that are known to increase the risk of seizures, alcohol abuse, or head injury. People with diabetes who are using glucose-lowering drugs or insulin and people who are using drugs to treat anorexia may also have a higher risk of seizures with bupropion.

    NICE guidance

    The guidance applies to all forms of nicotine replacement therapy and Zyban, the guidance is clear that the choice of which treatment to use should be influenced by the patients personal preference.

    9. The NICE guidance also recommends that:

  • Smokers who are under the age of 18 years, pregnant or breastfeeding, or 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 a smokers attempt to quit is unsuccessful, another course of NRT or bupropion should not usually be prescribed 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 initial attempt to quit.)

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

    Information on NICE

    10. Copies of the full guidance and supporting documentation will be available on the NICE web site (www.nice.org.uk) from midday on 11th April 2002.

    11. Health professionals are expected to take the Institute's guidance fully into account when exercising their clinical judgement for individual patients. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

    12. The National Institute for Clinical Excellence (NICE) is a part of the NHS. Part of its work is technology appraisals. The Institute produces guidance for both the NHS and patients on medicines, medical equipment and clinical procedures based on evidence of clinical and cost effectiveness. Each appraisal takes an average 12 months to complete and involves the manufacturers of the technology, groups that represent patients/carers and healthcare professionals.

    13. It is the Medicines Control Agency that determines whether a drug is safe and subsequently licence it for sale in the UK. NICE issues guidance on good clinical practice for the NHS to ensure access to effective care for people in England and Wales. NICE recommendations are considered and objective and take account of the licence granted by the MCA, the patient's perspective as well the views of professionals who care for them.

    14. NICE promotes clinical and cost effectiveness through its technology appraisals, clinical guidelines and audit tools. The Institute supports the work of those who make the complex treatment decisions - doctors, nurses, and other health professionals. The needs of the patient are central to NICE's work, and the Institute has forged strong links with patient groups and representatives.

    15. Topics for the NICE work programme are selected by the Department of Health and the National Assembly for Wales. NICE advises the NHS on how these technologies can best be used. It is also responsible for the production of national clinical guidelines, promoting best practice throughout the NHS. To support and assess the implementation of such guidelines, audit tools are produced for use in the clinical setting.