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Stop smoking treatments

If you smoke, giving up is probably the biggest single step you can take to improve your health.

Smoking is responsible for one in every five deaths in adults aged over 35 in England, and half of all long-term smokers will die prematurely due to a smoking-related disease.

Giving up smoking increases your chances of living a longer and healthier life, even if you’ve smoked for 40 years. You’ll start to notice the benefits soon after quitting. For example:

  • after one month your skin will be clearer, brighter and more hydrated
  • after three to nine months your breathing will have improved, and you will no longer have a cough or wheeze
  • after one year your risk of heart attack and heart disease will have fallen to about half that of a smoker

NHS Stop Smoking service

If you want to quit smoking, it’s a good idea to see your GP who can provide help and advice about quitting, and refer you to an NHS Stop Smoking service. These services offer the best support for people who want to give up smoking.

Studies show that you’re four times more likely to quit smoking if you do it through the NHS. You can make an appointment without seeing your doctor by calling the NHS Stop Smoking helpline on 0300 123 1044 (England only).

 

Stop smoking help from your GP

If you don’t want to go to an NHS Stop Smoking service, your GP can still offer treatment to help you quit.

You’ll be assessed to get an idea of your level of addiction and to outline the benefits of quitting. This is also a chance to identify potential triggers, such as if you live with others who smoke or you’re under stress.

Your GP can prescribe several different stop smoking treatments. The type prescribed will depend on your personal preference and whether you’ve used any before.

Read on to learn about the different treatments you may be offered. You can also see a summary of the pros and cons of these treatments, which allows you to easily compare your options.

Nicotine replacement therapy (NRT)

After smoking for a while your body adapts to getting regular doses of nicotine from your cigarettes. When you stop smoking you quickly remove the nicotine in your body. This means you suffer withdrawal, leading to:

  • bad moods
  • feeling irritable
  • difficulty concentrating
  • a craving for cigarettes

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 control your cravings for a cigarette  when your body starts to miss the nicotine from smoking and improves your mood.

NRT comes in different forms, including:

  • skin patches
  • chewing gum
  • inhalators, which look like plastic cigarettes through which nicotine is inhaled
  • tablets, strips and lozenges, which you put under your tongue
  • nasal spray
  • mouth spray

Your GP can prescribe NRT or you can buy it.

There’s no evidence that one particular type of NRT is more effective than another. The one you choose is down to personal preference.

When deciding, it helps to 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 an NRT nasal spray or mouth spray, because they’re the fastest-acting form of NRT.

Some smokers find it useful to combine NRT products. For example, they wear patches through the day, then use gum or an inhalator to help relieve a sudden craving for a cigarette. There’s good evidence this is more effective than using only one type of NRT and can be particularly helpful for heavy smokers.

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

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 the dose or type of NRT may need to be adjusted.

Nicotine replacement therapy and pregnancy

If you’re pregnant or breastfeeding and you want to quit smoking, it’s best to stop completely and immediately without any treatment.

But if you feel you can’t quit without help, your GP may recommend NRT to control your cravings.

There’s no evidence that nicotine harms your baby although we can’t be sure it’s safe. However cigarettes give more nicotine than NRT and also give other poisons such as carbon monoxide, which can reduce the oxygen in your baby’s blood.

So, although using NRT is not ideal for your baby, the risks are far outweighed by the risks of continuing to smoke.

Stop smoking medication

Two medications are available on the NHS to help you stop smoking.

Zyban (bupropion)

Bupropion was originally designed to treat depression, but it was discovered that it also helped people quit smoking. It’s not entirely clear why, but most experts believe it affects parts of the brain involved in addictive behaviour.

Bupropion is prescribed as one to two tablets a day.

You need to take bupropion for 7-14 days before you try to quit as the medication takes this long to reach its maximum effect. A course of treatment usually lasts 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’s not suitable for people who already have a higher-than-average risk of having seizures, such as people:

  • with epilepsy
  • with bipolar disorder
  • with serious alcohol misuse problems
  • 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

Champix (varenicline)

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

At the same time it gently stimulates your nicotine receptors, like nicotine does. This means it reduces the bad moods and irritability people can feel when they stop smoking.

It’s really important with all medications that you set yourself a quit day. This is a day where once you reach it you promise yourself that you do everything you can to make sure you don’t smoke again. Set this quit day 7-14 days after starting varenicline.

It’s recommended you take varenicline for 12 weeks. If you successfully stop smoking in this time, you may be prescribed another 12 weeks of treatment to ensure 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

There have been reports of people experiencing feelings of depressionand suicidal thoughts after beginning treatment with varenicline.

While there’s no evidence these symptoms are caused by the medicine, if you feel depressed or have thoughts of suicide, stop taking varenicline immediately as a precaution, and contact your GP.

Electronic cigarettes

Electronic cigarettes – or e-cigarettes – are electrical devices that mimic real cigarettes by producing a vapour that’s potentially less harmful than tobacco smoke. Many e-cigarettes contain nicotine and, when they do, it’s the vapour that gives the nicotine hit.

Since their emergence around five years ago, using e-cigarettes – or ‘vaping’ – has become increasingly popular. They’re typically marketed as a healthier (and cheaper) alternative to traditional cigarettes.

And, because they don’t smell or produce smoke, they may be used in places where smoking is banned, like bars, restaurants, public transport, planes and even hospitals (though it is courteous to get permission from those around you beforehand). However, some transport services, pubs and hospitals have taken the decision to ban e-cigarettes from their premises.

E-cigarettes are currently not available on the NHS. They’re not the same as the inhalator, which is a type of nicotine replacement therapy that is available on the NHS.

Electronic cigarettes also aren’t currently regulated as medicines so you can’t be sure of their ingredients or how much nicotine they contain – whatever it says on the label. Plans have been announced to regulate electronic cigarettes from 2016, but until this happens, they are only covered by general product safety legislation.

While e-cigarettes may be safer than conventional cigarettes, we don’t yet know the long-term effects of vaping on the body. There are clinical trials in progress to test the quality, safety and effectiveness of e-cigarettes, but until these are complete, the government can’t give any advice on them or recommend their use.

Cutting down before you quit

If you don’t feel ready to stop smoking completely, your GP may suggest a method of quitting known as nicotine-assisted reduction to stop. This involves using NRT to cut down before you eventually stop smoking.

If your GP suggests this approach, you will be prescribed NRT gum or an inhalator to use between cigarettes. These forms of NRT are best for use between cigarettes because they release a short burst of nicotine, rather than patches for example, so the NRT offers a safe substitute for your cigarettes.

When cutting down, you should try and prolong the gaps between cigarettes for as long as you can, and steadily reduce the number of cigarettes you smoke.

By six weeks of NRT treatment, you should aim to have cut your usual cigarette consumption by half and have stopped smoking completely by six months. The quicker you can cut down, the better. If you feel ready, it’s best to have a quit day.

Smoking during pregnancy

Stopping smoking during pregnancy is also one of the best things you can do to give your child a healthy start in life.

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