13 Eight RCTs involving 2199 participants met the entry criteria. An evidence review conducted by JBI examined studies that had measured the outcome of smoking cessation in later pregnancy. Nicotine exposure in utero has been linked to harmful effects on the fetus in animal studies however, in the small number of studies of NRT in humans, no adverse effects have been reported. For this reason, psychosocial intervention (eg counselling, feedback, financial incentives) are first-line treatment for women who are pregnant. 12 However, a systematic review of four trials conducted by JBI found evidence that longer term NRT can help reduce relapse in those who are abstinent at the end of a standard course or who have quit unassisted – see recommendations in Table 1.Īn area of ongoing uncertainty has been the effectiveness and safety of NRT (and other smoking cessation medications) in pregnancy. Longer NRT treatment duration has been investigated in two randomised trials of longer treatment (up to 52 weeks) in comparison to standard course (8 weeks), but the studies found no convincing benefit. 11 This approach has approval from the Therapeutic Goods Administration (TGA) and is also subsidised by the Pharmaceutical Benefits Scheme (PBS). In one meta-analysis, pre-cessation treatment (starting two weeks before quit day) with nicotine patches has been found to increase success rates when compared with standard therapy. Guide to prescribing nicotine replacement therapy (NRT), Wellington, Ministry of Health, 2014. Click here to enlargeĪdapted with permission from Ministry of Health, New Zealand. Nicotine replacement therapy initial dosage guideline. A guide to initial NRT dosing is shown in Figure 4.įigure 4. 10 It is important to advise patients on the correct use of the different forms of NRT to ensure an adequate dose is taken to relive cravings and withdrawal symptoms, and to encourage sufficient length of treatment.
Methods to quitting smoking Patch#
10 Combining a nicotine patch with faster-acting NRT increases 6–12-month abstinence rates by 5% over NRT monotherapy. NRT monotherapy is modestly effective, increasing 6–12-month quit rates by 6% when compared with placebo. NRT is available in a long-acting form (nicotine patch) and in a variety of more rapidly acting oral forms (ie gum, lozenge, inhalator, mouth spray, oral strip). Reproduced with permission from The Royal Australian College of General Practitioners, Supporting smoking cessation: A guide for health professionals, 2nd edn, East Melbourne, Vic, RACGP, 2019, p. GP, general practitioner NRT, nicotine replacement therapy OTC, over the counter PBS, Pharmaceutical Benefits Scheme PI, product information They are therefore the preferred forms of treatment for most patients (Figure 3).įigure 3. 8,9 Current evidence indicates that varenicline and combination NRT are equally effective and are more effective than NRT monotherapy or sustained-release bupropion. Bupropion and NRT monotherapy, also accompanied by brief counselling, almost doubles the odds of quitting when compared with placebo at six months’ follow-up.
Methods to quitting smoking plus#
Meta-analyses of randomised controlled trials (RCTs) have shown that, when accompanied by brief counselling, varenicline or combination NRT (patch plus rapidly acting form) almost triples the odds of quitting when compared with placebo at six months’ follow up. The current options are nicotine replacement therapy (NRT various forms available), varenicline and sustained-release bupropion. First-line pharmacotherapy options are medicines for which there is high-level evidence of effectiveness and safety, in addition to being licensed in Australia for smoking cessation. Pharmacotherapy can assist smoking cessation for people who are nicotine dependent. Reproduced with permission from The Royal Australian College of General Practitioners, Supporting smoking cessation: A guide for health professionals, 2nd edn, East Melbourne, Vic: RACGP, 2019, p.
For some people it can be helpful to rehearse how to say no to a cigarette offer.Suggest avoidance of high-risk social situations early in the quit attempt.Point out that health benefits of quitting far exceed any adverse health effects of weight gain.Suggest strategies to minimise weight gain: healthy diet avoid high-fat and high-sugar foods and drinks regular physical activity.1 However, national targets to reduce daily smoking to 13 kg) Australia has been a global leader in tobacco control and has one of the lowest rates of daily smoking in the world (currently 12.2%).
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