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Helping patients quit smoking

Nicotine Replacement Therapy (NRT) and pharmacotherapy

85% of patients would appreciate their physician raising the topic of smoking cessation1.

It takes less than 3 minutes to help a smoker quit2.

Counselling advice lasting less than 3 minutes increases the odds of abstinence rates by 40%2

physician discussing smoking cessation

You can help your patient today by recommending stop smoking medication like NRT
 
NRT benefits

NRT Benefits

 

Health and Lifestyle Revival:
Quitting smoking is essential for improving patient’s health and wellbeing, reducing risks of serious illnesses like cancer3 and myocardial infarction4

 

NRT's Role:

NRT helps with nicotine addiction, by providing controlled doses to break the cycle5

 

Nicotine patch provides a low dose of nicotine that controls cravings, and the flexible format provides nicotine to help relieve situational cravings. This approach provides a general reduction of withdrawal symptoms and cravings after application6

 

NRT empowers individuals to take STEPS towards quitting.

WHY CHOOSE NRT?

 

Why choose NRT?

Help your patients take STEPS towards a life free from smoking with NRT:

 

 

*with the 7 formats

 

Available pharmacotherapies and how they work

    Nicorette®

  • Provides controlled doses of nicotine at lower and slower rates than a cigarette and is available in a variety of formats and flavours to suit patient's preferences
  • NRT has 45+ years of experience9

Cytisine

  • Cytisine, an alkaloid from the plant cytisus laburnum (golden rain), is a nicotine analogue which acts as a partial nicotinic acetylcholine receptor agonist12.
  • Cytisine has been used in eastern Europe for smoking cessation since the 1960s12.

Varenicline

  • The molecule is a selective nicotinic acetylcholine receptor partial agonist that binds specifically at the α4β2 nicotinic receptor subtype13.
  • Varenicline tartrate was originally developed as a smoking cessation agent in 1997 based on the molecular structure of cytisine13.

Bupropion

  • Bupropion is an aminoketone antidepressant that is widely used in therapy of depression and smoking cessation. It appears to act via noradrenergic or dopaminergic mechanisms. Although its mechanism of action is unclear, it seems to act as an antagonist at the nicotinic acetylcholine receptor14,1.
  • Bupropion has been licensed for depression in the United States since the late 1980s16 and it was then licensed in the United States (US) in 1997 for smoking cessation15.

NRT offers a tailored and flexible dosing schedule

Nicorette®

  • Simple dosing: patch in the morning then a fast-acting format if cravings occur7 
  • Simple: on-the-go formats that do not need water to take 

 

Flexible options: designed to support patient adherence

  • 7 formats to tailor to preferences and lifestyles17 
  • Monotherapy or combination therapy17 
  • Can be adjusted to patient taste with a variety of flavours17
Nicorette Invisipatch

Cytisine/Varenicline/Bupropion:

 

Cytisine: Fixed dosing regimen

  • First 3 days: 1.5mg every 2 hours
  • Days 4-12: 1.5mg every 2.5 hours
  • Days 13-16: 1.5mg every 3 hours
  • Days 17-20: 1.5mg every 5 hours
  • 1 format: tablets

Varenicline: Fixed dosing regimen

  • First 3 days: 0.5mg once daily
  • Days 4-7: 0.5mg twice daily
  • Day 8 to end of treatment: 1mg twice daily
  • 1 format: tablets

Bupropion: Fixed dosing regimen

  • First 6 days: 150mg daily
  • Day 7 to end of treatment: 150mg twice daily
  • There should be an interval of at least 8 hours between doses
  • 1 format: tablets (immediate or sustained release)

To keep in mind:

  • NRT offers a tailored and flexible dosing schedule to support

NRT can be continued if relapse occurs and can be tailored to different situations

Experiencing a slip-up is normal. If your patients have a setback on their quitting journey, they need not to be too hard on themselves. It’s best to encourage them to try again.

NRT:

  • Is suitable for continued use if relapse occurs21
  • Can be used as reduce to quit21
  • NHS advises that treatment usually lasts 8-12 weeks before gradually reducing and stopping22. Treatment duration can vary according to patient's needs23.
  • Can be tailored to different situations and lifestyles thanks to the different formats to manage physiological and situational cravings24
NRT Relapese

Varenicline:

  • Must stop smoking by the 5th day of treatment, and not smoke concurrently to avoid aggravating adverse reactions18
  • Tablets should be discontinued in cases of treatment failure and can be resumed after 2-3 months18
  • Cannot be used as needed when cravings occur

Cytisine:

  • Recommended to stop smoking after 1-2 weeks of starting 12 week course (abrupt quit)19
  • Recommended to stop smoking by 12th week of starting 24 week course (reduce to quit)19
  • Can be used for longer than 12 weeks if required19
  • Cannot be used as needed when cravings occur

Bupropion:

  • Recommended to stop smoking within 2 weeks of 7-9 week course20
  • If at 7 weeks no effect is seen, treatment should be discontinued20
  • Cannot be used as needed when cravings occur

To keep in mind:
NRT offers:

  • A management of cravings when they occur
  • A reduce to quit option if they still smoke
  • Tailored approaches to suit patient's lifestyles*
  • Continued NRT usage in the event of relapse so patient can continue their quit journey

*with the 7 formats

How effective is pharmacotherapy? 
NRT Combination Therapy:

 

  • NRT increases chances of quitting vs placebo/no treatment25
  • Combination therapy is 27% more effective than single NRT26
    Risk Ratio: 1.27, 95% CI: 1.17–1.37; anticipated absolute effects: quit rates with monotherapy 137 per 1000, quit rates with combination NRT 174 per 1000
     

NICE guidance on stop smoking medicines:8

  • NRT monotherapy: recommended as second line treatment
  • NRT combination therapy: recommended as first line treatment
  • Cytisine: Under consultation to add as first line treatment
  • Varenicline: recommended as first line treatment
  • Bupropion: recommended as second line treatment
How effective is pharmacotherapy

Cytisine:

  • Cytisine increases chances of quitting vs placebo/no treatment27

Varenicline:

  • Varenicline increases chances of quitting vs placebo/no treatment27

Bupropion:

  • Bupropion increases chances of quitting vs placebo27
  • Bupropion has lower quit rates than Combination NRT (RR 0.74 [95% CI: 0.55 to 0.98])28

To keep in mind:

  • No robust data to differentiate NRT combination therapy and cytisine or varenicline quit rates
  • NRT combination therapy has higher quit rates than bupropion
  • NRT, cytisine, varenicline and bupropion are effective for quitting smoking
  • Understanding your patient’s needs and lifestyle can help you determine the right treatment option for them

*with the 7 formats

NRT is the most prescribed treatment for smoking cessation29

Nicorette®:

  • Nicorette® is suitable for:
    - Adolescents 12 years old and plus7.
    - Pregnant and breast-feeding women - for those unable to quit without pharmacological support7
    - No clinically relevant interactions between nicotine replacement therapy and other drugs have definitely been established7.
  • Globally available over-the-counter9


Included in:

WHO policy recommendation and Model List of Essential Medicine since 200930-32

European Network for Smoking and Tobacco Prevention (ENSP) Tobacco Dependence
Treatment Guidelines33

NRT Combination Therapy is recommended by NICE as a first-line treatment option8

NRT single therapy is recommended by NICE as a second-line treatment option8

How effective is pharmacotherapy

Cytisine:

  • Suitable for 18+18


Included in:

  • World Health Organization’s Policy 
  • Recommendation and Model List of Essential Medicines 202430.31
  • ENSP Tobacco Dependence Treatment Guidelines33
  • Under consultation to add as first line treatment option8

Varenicline:

  • Suitable for 18+19


Included in:

  • World Health Organization’s Policy 
    Recommendation and Model List of Essential Medicines 202130.31
  • ENSP Tobacco Dependence Treatment Guidelines33
  • Varenicline is recommended by NICE as a first-line treatment option8

Bupropion:

  • Suitable for 18+20


Included in:

  • World Health Organization’s Policy 
  • Recommendation and Model List of Essential Medicines 202130.31
  • ENSP Tobacco Dependence Treatment Guidelines33
  • Bupropion is recommended by NICE as a second-line treatment option8

To keep in mind:

  •  NRT Combination Therapy is one of the most effective ways to help your patient quit for good8

Speed of action and cravings relief

Observational field studies indicate that cue-induced cravings are substantially responsible for relapse to smoking35. Half of studied acute craving episodes lead to lapse within 11 minutes35

Nicorette® Quickmist Mouthspray is clinically proven to start relieving cravings in 30s11

  • A maximum concentration of 5.3 ng/mL is reached within 13 minutes after administration of a 2 mg dose36

Nicorette®: faster-acting formats: relieve sudden cravings whenever they strike

  • Faster-acting Nicorette® formats such as: QuickMist Mouthspray, Gum, Lozenge, Inhalator or Nasal Spray are absorbed by the oral or nasal mucosa7
  • Can be used to prevent and/or relieve sudden cravings when they strike5
How effective is pharmacotherapy

Cytisine:

  • Indicated for reduction of nicotine cravings in smokers who are willing to stop smoking18

Varenicline:

  • Indicated to help relieve the craving and withdrawal symptoms associated with stopping smoking19

Bupropion:

  • Indicated as aid to smoking cessation in combination with motivational support in nicotine-dependent patients20

To keep in mind:

  • With NRT your patients can get craving relief when they strike7

Support your patient by asking whether they smoke, and recommend stop smoking medication like Nicorette® Combination Therapy 
 
NRT combination therapy

Nicorette® Combination Therapy:

  • Combining two formats for Nicorette® Combination Therapy can help to manage nicotine withdrawal symptoms with a long acting patch and a flexible format for cue induced or breakthrough cravings
  • Patch relieves smoking cravings discreetly and continuously – over 16 hours37, and doesn't add to sleep disturbance
  • Mouthspray starts to relieve withdrawal symptoms – in just 30 seconds11 

Nicorette® Combination Therapy options11,37-42

See the range guide here

  1. Slama KJ et al. Family Practice 1989;6(3):203-209.
  2. Fiore MC, et al. Am J Prev Med. 2008 Aug;35(2):158-76.
  3. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR). MMWR Surveillance Summary 2008;57(SS08);1–33. Available at: CDC Report. Accessed July 2024.
  4. Ambrose JA, Barua RS. J Am Coll Cardiol. 2004;43(10):1731–7.
  5. Sweeney CT, et al. CNS Drugs. 2001;15(6):453–67.
  6. NCSCT 34 tion NRT v3.fh11.
  7. Nicorette® Summary of Product Characteristics.
  8. National Institute for Health and Care Excellence guideline (NG209) Tobacco: preventing uptake, promoting quitting and treating dependence (2023). Available at: NICE Guideline.
  9. Fernö, O. Addiction. 1994;89,1215–1226.
  10. Kenvue internal data.
  11. McCaffrey, V., et al., Pharmacodynamic effects of nicotine mouth spray and cytisine tablet. A study in adult healthy smokers. Consilium Medicum, 21(11), pp.28-33.
  12. Tinghino B, Cardellicchio S, Corso F, et al. Cytisine for smoking cessation: A 40-day treatment with an induction period. Tobacco Prevention & Cessation. 2024;10(May):23. DOI: 10.18332/tpc/187556.
  13. Expert Opin Drug Discov. 2018 Jul; 13(7): 671–683.
  14. Sweetman S (2011). Martindale: The Complete Drug Reference (37th ed.). Pharmaceutical Press. p. 402. ISBN 978-0-85369-982-8.
  15. Wilkes S. The use of bupropion SR in cigarette smoking cessation. Int J Chron Obstruct Pulmon Dis. 2008;3(1):45-53. DOI: 10.2147/copd.s1121.
  16. Fava, M., et al., 15 years of clinical experience with bupropion HCl: from bupropion to bupropion SR to bupropion XL. Primary Care Companion to the Journal of Clinical Psychiatry, 2005, 7(3), p.106.
  17. Academy+. Combination NRT. Available at: Academy+. Accessed January 2025.
  18. Cytisine 1.5mg tablets. Summary of Product Characteristics.
  19. Varenicline 0.5mg tablets. Summary of Product Characteristics.
  20. Bupropion 150mg tablets. Summary of Product Characteristics.
  21. Nicorette® 2mg Gum. Summary of Product Characteristics.
  22. NHS. Stop smoking treatments. Available at: NHS. Accessed January 2025.
  23. NICE Guidelines
  24. Ferguson SG, Shiffman S. J Substance Abuse Treatment 2009; 36: 235-243.
  25. Hartmann-Boyce J, et al. Cochrane Database of Systematic Reviews 2018, Issue 5. DOI: 10.1002/14651858.CD000146.pub5.
  26. Theodoulou A et al. Cochrane Database of Systematic Reviews 2023, Issue 6. DOI: 10.1002/14651858.CD013308.pub2.
  27. Lindson N et al. Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses. DOI: 10.1002/14651858.CD015226.
  28. Hajizadeh A, et al. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2023;5:CD000031.
  29. IQVIA Prescription sales data MAT Oct 2024.
  30. World Health Organization. Policy recommendations for smoking cessation and treatment of tobacco dependence: tools for public health. 16 July 2012. WHO Report. Accessed July 2024.
  31. World Health Organization. WHO Model List of Essential Medicines 2021. WHO Essential Medicines. Accessed July 2024.
  32. Kishore SP, Bitton A, Cravioto A, Yach D. Enabling access to new WHO essential medicines: the case for nicotine replacement therapies. Global Health. 2010 Nov 19;6:22. DOI: 10.1186/1744-8603-6-22.
  33. European Network for Smoking and Tobacco Prevention. 2020 Guidelines for Treating Tobacco Dependence. Available at: ENSP Guidelines. Accessed July 2024.
  34. Lindson N, et al. Modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 4. DOI: 10.1002/14651858.CD013308.
  35. Ferguson SG, Shiffman S. J Substance Abuse Treatment 2009; 36: 235-243.
  36. Nicorette® QuickMist 1mg/spray mouthspray. Summary of Product Characteristics.
  37. Nicorette® Invisi 25 mg Patch. Summary of Product Characteristics.
  38. Nicorette® 4 mg Gum. Summary of Product Characteristics.
  39. Nicorette® 4mg lozenge. Summary of Product Characteristics.
  40. Nicorette® 15mg Inhalator. Summary of Product Characteristics.
  41. Nicorette® 10mg/ml Nasal Spray. Summary of Product Characteristics.
  42. Nicorette® 2mg Microtab. Summary of Product Characteristics.

Date of preparation: January 2025
UK-NIC-2024-83743