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Nicotine-containing Chewing Gum as an anti- Psychopharmacologia 1973 31 191-200 REPLACEMENT
Smoking cessation in the workplace: results of intervention programme using nicotine patches Occupational Medicine 2001 51 501-6 Cochrane Database 2002 4 CD000146 Update THERAPY AND
Smith L. and Fowler G.
Nicotine should be prescribed on the NHS Patient Fact Sheet for Nurse Practitioners Nursing Standard 2002 November 20-26 17 (10) Their Place in Smoke-Free Hospital Policies
Fioree M.C., Bailey W.C., Cohen S.J. et al Treating tobacco use and dependence: clinical Self-help interventions for smoking cessation Cochrane Database 2002 CD001118 Review Rockville, Md: US Department of Health andHuman Services 2000 Campaign Guidance Leaflet No. 3
Efficiency of nicotine lozenges for smoking National Institute for Clinical Excellence.
Guidance on the use of nicotine replacement International Network Towards Smoke-Free Hospitals
Brit J. Community Nursing 2002 7 202-5 cessationLondon, England NICE Technology 2002 NICE Technology Appraisal Guidance No. 39 THE INTERNATIONAL NETWORK
Nicotine replacement therapy (NRT) and bupropion are now accepted as helpful for people wanting tostop smoking. When used with support effectiveness can be further increased. They therefore have a placein smoke-free hospital policies as methods appropriate to offer staff and patients.
United Kingdom Registered Charity Number 1004061 Both assist people to escape from their addiction. NRT enables the individual to cope with cravings for The International Network Towards Smoke-Free Hospitals is a non-governmental organization, nicotine by giving nicotine in a different form from that in cigarettes. Withdrawal symptoms are thus financed by voluntary contributions and registered in the United Kingdom as a charity, reduced. Bupropion is a sustained release drug which is presumed to work directly on the brain pathways which is devoted to promoting smoke-free hospitals world wide.
involved in addiction and withdrawal, although the exact mechanism is unclear.
Currently there is insufficient evidence to recommend the use of NRT and bupropion in combination.
The Network is grateful for the help with the cost of printing this guide from GlaxoSmithKline.
Authoritative agencies have recommended that smokers should use NRT when trying to quit smoking. It 45 Brooskcroft, Linton Glade, Croydon, United Kingdom CRO 9NA
has been shown to double the chances of giving up smoking when compared with a placebo, regardless Telephone: +44 208 651 5436 (in the UK: 020 8651 5436) of any other intervention. The Cochrane Library review of NRT for smoking cessation, issued in 2003, Facsimile: +44 208 651 3428 (in the UK: 020 8651 3428) indeed states: ‘The effectiveness of NRT appears to be largely independent of the intensity of additionalsupport provided to the smoker.’ It is generally accepted that back up from professionals should be offered with NRT or bupropion: this can be provided in smoke-free hospital policies. For success each aidrequires a desire to give up smoking on the part of the individual.
The American Lung Association reiterated its among the most effective of all health care ABOUT NRT.
endorsement of NRT in January, 2003.
NRT was introduced to provide a background level Bupropion is a sustained release drug for smoking Health Canada considers that clinical trials have The United Kingdom's Health Department has of nicotine that reduces craving and withdrawal. It cessation. It is a relatively weak but selective shown the NRT patch to be effective in helping entered into an agreement with the manufacturers replaces the intake of nicotine from cigarettes with inhibitor of the neuronal up-take of dopamine and some individuals to stop smoking, particularly of NRT products. This agreement allows the low dose nicotine which goes into the body when used in combination with counselling, government to recoup some of its investment if the differently from the nicotine from cigarettes. And it cessation programmes and other support.
market grows beyond certain levels. As a result the Some smokers who cannot give up smoking by does not contain the other 40 known carcinogens more local health services invest up front in these using NRT are able to do so using bupropion. And The British National Institute for Clinical in tobacco smoke or the cigarette smoke’s smoking cessation products, the more they will get vice versa. So the two methods separately (but not Excellence recommended NRT and bupropion for back to reinvest in smoking prevention.
smokers who have expressed a desire to quit It is a crutch to help the individual through the smoking, in its Guidance on the use of NRT and Risks? Because the most clinically important withdrawal symptoms of smoking, which can be bupropion for Smoking Cessation, issued in March adverse events associated with bupropion are used less and less and be finally disposed of as the 2002. ‘Both bupropion and NRT are considered seizures (they occur in about 1 in a 1000 patients), dependency decreases and ceases. By reducing the it should not be prescribed for smokers with a withdrawal symptoms associated with smoking it current seizure disorder or history of seizures.
helps people to resist the desire to smoke.
Pregnant or breast feeding women should not be There are a number of forms of delivery of NRT. To National Institute for Clinical Excellence:
date there is no evidence that one form of NRT is United Kingdom Department of Health
• NICOTINE PATCHES placed on the skin release a USEFUL REFERENCE
rate controlled supply of nicotine. They are Cochrane Library
available in 16-hour and 24-hour forms.
• NICOTINE GUM provides nicotine for absorption Intervention for smoking cessation in hospital Canadian Cessation Programme
through the lining of the mouth. Clinical trials show that, when used with some type of support, American Lung Association
• NICOTINE NASAL SPRAY. Nicotine going in through the lining of the nose is absorbed fast and Higher dosage nicotine patches increase one year factsheet99.html so the spray is suited to people experiencing smoking cessation rate. Collaborative European severe withdrawal symptoms or who have high***4615 • NICOTINE TABLET dissolves under the tongue.
make them more acceptable for keeping in themouth, while their nicotine is released slowly.
The Nursing Standard produced a brief but comprehensive patient fact sheet on NRT which How effective is Nicotine Replacement Therapy in can be freely photocopied to give to patients.
Any risks? Professionals advising on NRT need to balance possible contraindications for certain The reference is: Nursing Standard, November 20, volume 17, number 10. 2002.
groups with the harm which would be associatedwith the individual continuing to smoke without The groups needing caution about the use of NRT ‘Both bupropion and NRT are considered to be among the most cost effective of all include persons with cardiovascular disease, healthcare interventions.‘ -National Institute for Clinical Excellence, advisory body for Britain’s hyperthyroidism, diabetes mellitus, severe renal or hepatic impairment and peptic ulcer. And pregnant Patient smoking cessation - treatment strategies


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