Guidance 1.1 Nicotine replacement therapy (NRT) and bupropion are recommended for smokers who have expressed a desire to quit smoking.
1.2 NRT or bupropion should normally only be prescribed as part of an abstinent-contingent treatment (ACT), in which the smoker makes a commitment to stop smoking on or before a particular date (target stop date). Smokers should be offered advice and encouragement to aid their attempt to quit. Ideally, initial prescription of NRT or bupropion should be sufficient to last only until 2 weeks after the target stop date. Normally, this will be after 2 weeks of NRT therapy, and 3-4 weeks for bupropion, to allow for the different methods of administration and mode of action. Second prescriptions should be given only to people who have demonstrated that their quit attempt is continuing on reassessment.
1.3 It is recommended that smokers who are under the age of 18 years, who are pregnant or breastfeeding, or who have unstable cardiovascular disorders, should discuss the use of NRT with a relevant health-care professional before it is prescribed.
1.4 Bupropion is not recommended for smokers under the age of 18 years, as its safety and efficacy have not been evaluated for this group. Women who are pregnant or breastfeeding should not use bupropion.
1.5 If a smokers attempt to quit is unsuccessful with treatment using either NRT or bupropion, the NHS should normally fund no further attempts within 6 months. However, if external factors interfere with an individuals initial attempt to stop smoking, it may be reasonable to try again sooner.
1.6 There is currently insufficient evidence to recommend the use of an NRT and bupropion in combination.
1.7 In deciding which of the available therapies to use and in which order they should be prescribed, practitioners should take into account: - Intention and motivation to quit, and likelihood of compliance - The availability of counselling or support - Previous usage of smoking cessation aids - Contraindications and potential for adverse effects - Personal preferences of the smoker