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This Week - Q : Quit Smoking

If you want to stop smoking, several different treatments are available from shops, pharmacies and on prescription to help you beat your addiction and reduce withdrawal symptoms.

The best treatment for you will depend on your personal preference, your age, and any medical conditions you have. Speak to your GP or an NHS stop smoking adviser for advice.

Research has shown that all these methods can be effective. Importantly, evidence shows that they are most effective if used alongside support from an NHS stop smoking service.

Nicotine replacement therapy (NRT)

The main reason that people smoke is because they are addicted to nicotine.

NRT is a medicine that provides you with a low level of nicotine, without the tar, carbon monoxide and other poisonous chemicals present in tobacco smoke.

It can help reduce unpleasant withdrawal effects, such as bad moods and cravings, which may occur when you stop smoking.

Where to get it and how to use it

NRT can be bought from pharmacies and some shops. It's also available on prescription from a doctor or NHS stop smoking service.

It's available as:

• skin patches
• chewing gum
• inhalators (which look like plastic cigarettes)
• tablets, oral strips and lozenges
• nasal and mouth spray

Patches release nicotine slowly. Some are worn all the time and some should be taken off at night. Inhalators, gum and sprays act more quickly and may be better for helping with cravings.

There's no evidence that any single type of NRT is more effective than another. But there is good evidence to show that using a combination of NRT is more effective than using a single product.

Often the best way to use NRT is to combine a patch with a faster acting form such as gum, inhalator or nasal spray.

Treatment with NRT usually lasts 8-12 weeks, before you gradually reduce the dose and eventually stop.

Who can use it

Most people are able to use NRT, adults and children over 12 years of age - although children under 18 shouldn't use the lozenges without getting medical advice first.

Always read the packet or leaflet before using NRT to check whether it's suitable for you.

Sometimes it may be advisable to get medical advice first, for example if you have kidney or liver problems, or you've recently had a heart attack or stroke.

Possible side effects

Side effects of NRT can include:

• skin irritation when using patches
• irritation of nose, throat or eyes when using a nasal spray
• difficulty sleeping (insomnia), sometimes with vivid dreams
• an upset stomach
• dizziness
• headaches

Any side effects are usually mild. But if they're particularly troublesome, contact your GP as the dose or type of NRT may need to be changed.

Varenicline (Champix)

Varenicline (brand name Champix) is a medicine that works in 2 ways. It reduces cravings for nicotine like NRT, but it also blocks the rewarding and reinforcing effects of smoking.

Evidence suggests it's the most effective medicine for helping people to stop smoking.

Where to get it and how to take it

Varenicline is only available on prescription, so you'll usually need to see your GP or contact an NHS stop smoking service to get it.

It's taken as 1 to 2 tablets a day. You should start taking it a week or 2 before you try to quit.

A course of treatment usually lasts around 12 weeks, but it can be continued for longer if needed.

Who can take it

Most people can take varenicline, although there are some situations where it's not recommended. For example, it's not suitable:

• for children under 18 years old
• if you're pregnant or breastfeeding
• if you have severe kidney problems

Possible side effects

Side effects of varenicline can include:

• feeling and being sick
• difficulty sleeping (insomnia), sometimes with vivid dreams
• dry mouth
• constipation or diarrhoea
• headaches
• feeling drowsy
• feeling dizzy

Speak to your GP if you have any problems with side effects.

Bupropion (Zyban)

Bupropion (brand name Zyban) is a medicine originally used to treat depression, but it has since been found to help people quit smoking.

It's not clear exactly how it works, but it's thought to have an effect on the parts of the brain involved in addictive behaviour.

Where to get it and how to use it

Bupropion is only available on prescription, so you'll usually need to see your GP or contact an NHS stop smoking service to get it.

It's taken as 1 to 2 tablets a day. You should start taking it a week or 2 before you try to quit.

A course of treatment usually lasts around 7 to 9 weeks.

Who can take it

Most people can take bupropion, but there are some situations when it's not recommended. For example, it's not suitable if you:

• are under 18 years old
• are pregnant or breastfeeding
• have epilepsy, bipolar disorder or an eating disorder

Possible side effects

Side effects of bupropion can include:

• dry mouth
• difficulty sleeping (insomnia)
• headaches
• feeling and being sick
• constipation
• difficulty concentrating
• dizziness

Speak to your GP if you have any problems with side effects.

Serotonin syndrome

Serotonin syndrome is an uncommon, but potentially serious, set of side effects linked to some medicines. It happens when the levels of a chemical called serotonin in your brain become too high.

There's a risk of serotonin syndrome if you take more than your prescribed dose of bupropion, or if you take certain other medicines with bupropion such as:

• selective serotonin reuptake inhibitors (SSRIs)
• serotonin noradrenaline reuptake inhibitors (SNRIs)

Contact your GP or NHS 111 if you have any symptoms of serotonin syndrome, including:

• feeling or being sick
• diarrhoea
• increased heart rate
• feeling agitated

You can call 111 or get help from 111 online.

E-cigarettes

An e-cigarette is an electronic device that delivers nicotine in a vapour. This allows you to inhale nicotine without most of the harmful effects of smoking, as the vapour contains no tar or carbon monoxide.

Research has found that e-cigarettes can help you give up smoking, so you may want to try them rather than the medicines listed above. As with other approaches, they're most effective if used with support from an NHS stop smoking service.

There are no e-cigarettes currently available on prescription.

For now, if you want to use an e-cigarette to help you quit, you'll have to buy one. Costs of e-cigarettes can vary, but generally they're much cheaper than cigarettes.

Read more about using e-cigarettes to stop smoking

If you want to find out more about this week's subject you can visit the Original article on the NHS website. If you are worried by any aspect of your health make sure you go and see your doctor or book an appointment at your local clinic.