Treatment & support

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, call the NHS Stop Smoking helpline on 0800 022 4332 (England), 0800 84 84 84 (Scotland).

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 to assess your level of addiction and to outline the benefits of quitting. They can also help you identify any factors that may make quitting difficult for you, such as living with others who smoke, or 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 you are prescribed will depend on your own personal preference, any previous smoking cessation medication that you have taken and any side effects they may cause. The different types of smoking cessation treatments, their side effects and the way they will be prescribed are detailed below.

Nicotine replacement therapy (NRT) - Can be prescribed by your GP

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 present in tobacco smoke.

This helps to control the cravings for a cigarette that occur when your body starts to miss the nicotine from smoking.

NRT is the most common smoking cessation treatment and it comes in many different forms, including:

transdermal patches (which stick to your skin), 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 plastic cigarettes through which nicotine is inhaled
tablets and lozenges, which are placed under your tongue
nasal spray, which passes nicotine through the lining of your nose

NRT can be prescribed by your GP. All forms of NRT can also be bought from a pharmacist over the counter.

There is no evidence that one particular type of NRT is more effective than another, so the one you choose is largely a matter of personal preference.

When deciding, think about the type of smoker you are. For example, are you a heavy smoker who needs a cigarette as soon as you wake up, or are you an occasional smoker who only smokes when they are out having a drink, or after a meal?

Some heavy smokers find a 24-hour patch useful, as it helps to relieve the cigarette craving when waking up. Others prefer using a NRT nasal spray, because it is the fastest-acting form of NRT.

Some smokers find it useful to combine NRT products. For example, they wear patches throughout the day, then use gum or an inhalation to help relieve a sudden craving for a cigarette.

Most courses of NRT last eight to 12 weeks before you gradually reduce the dose and eventually stop. Most people stop using NRT altogether within three months, although heavy smokers may need to use it for longer.

Side effects of NRT include:

skin irritation when using patches
irritation of nose, throat or eyes when using a nasal spray
disturbed sleep, sometimes with vivid dreams
upset stomach
dizziness
headaches

Side effects are usually mild to moderate, but if they become particularly troublesome, contact your GP as your dosage or type of NRT may need to be adjusted.

Also, use of the nasal spray can cause sneezing and watering eyes for a short time after use. For this reason, if you are prescribed an NRT nasal spray, do not use it while driving, or just before driving.

Nicotine replacement therapy and pregnancy

If you are pregnant or breastfeeding and you want to quit smoking, it is best for your and your baby's health that you stop completely and immediately without any smoking cessation treatment.

However, if you feel 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). So although using NRT is not ideal for your baby, the risks of nicotine are far outweighed by the risks of 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.

Medication

There are two medications that are currently licensed to help people give up smoking. These are discussed below.

Bupropion

Bupropion is a medication originally designed to treat depression, but it was discovered that it helped people quit smoking. It is still not entirely clear why this is the case.

Most experts believe it has something to do with the medication affecting parts of the brain that are involved in addictive behaviour.

Bupropion is prescribed in tablet form, with people taking one to two tablets a day, as directed by their GP.

Take bupropion for 7-14 days before you try to quit smoking as the medication takes this amount of time to reach its maximum effect. A course of treatment usually lasts for seven to nine weeks.

Bupropion is not suitable for:

children and young people under 18
women who are pregnant or breastfeeding
people with anorexia or bulimia
people with a central nervous system tumour
people with severe cirrhosis of the liver

Bupropion can also increase your risk of having a seizure (fit), so it is not suitable for people who already have a higher-than-average risk of having seizures, such as:

people with epilepsy
people with bipolar disorder
people with serious alcohol misuse problems
people who are treating diabetes with hypoglycaemic medication or insulin

Bupropion can cause several side effects, including:

dry mouth
upset stomach
insomnia (trouble sleeping)
headaches
difficulty concentrating
dizziness
drowsiness

If you feel drowsy after taking bupropion, do not drive or operating heavy or complex machinery.

Varenicline

Varenicline is currently the only medication that has been specifically designed to help people quit smoking.

It works by preventing nicotine from binding to receptors (parts of your brain that respond to nicotine), which eases cravings and reduces the rewarding and reinforcing effects of smoking.

If you have not stopped smoking completely before starting varenicline, aim to do so within 7-14 days of starting treatment. The recommended duration of varenicline is 12 weeks. If you successfully stop smoking in this time, you may be prescribed another 12 weeks of treatment to ensure that you do not start smoking again.

Varenicline is not suitable for:

children and young people under 18
women who are pregnant or breastfeeding
people with epilepsy
people with advanced kidney disease

Side effects of varenicline include:

nausea and vomiting
headaches
insomnia (trouble sleeping)
unusual dreams
increased appetite
constipation or diarrhoea
swollen stomach
slow digestion
flatulence
dry mouth
tiredness
dizziness
drowsiness

Do not drive or operate machinery while taking varenicline if it makes you feel drowsy.

There have been reports of a number of people experiencing feelings of depression and suicidal thoughts after beginning treatment with varenicline.

While there is no evidence that these symptoms are directly linked to the medication, if you do feel depressed or have thoughts of suicide, stop taking varenicline immediately as a precaution, and contact your GP.