16 November 2021

Access and flexibility in smoking cessation

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When a patient does commit to quit, lowering barriers to drug therapies is essential.


Engaging patients to move from smoking to the first stage of their quit journey remains a key challenge for doctors.

Combination NRT can be offered as a substitute for prescription smoking cessation medicines to retain patients on their quit attempt.1

Smoking remains the leading cause of preventable deaths both in Australia and globally.1 Delivering smoking cessation messages to patients is a continual challenge. So when a patient does commit to quit, minimising barriers to accessing pharmacotherapies is essential. 

Nicotine Replacement Therapy (NRT) is indicted as a first-line treatment for smoking cessation. Combination NRT is as effective as varenicline and more effective than single types of NRT1. Patients who have been affected by varenicline shortages can be offered NRT as a substitute. A recommended guide is also available for download here.


Counselling – For sustained release to mitigate cravings

Week 1-6: Step 1: 25mg

Week 7-8: Step 2: 15mg

Week 9-10: Step 3: 10mg

Week 11+ or as needed for up to 6 months If strong cravings return, consider remaining at Step 3 for 2 more weeks or longer if necessary


COMBINED WITH

Counselling: Provides rapid uptake of nicotine. For patients who experience cravings that come on quickly. Encourage patients to have on hand.

Week 1-6: 1-2 sprays every half hour as needed. Max 64 sprays per day.

Week 7-8: 1-2 sprays every half hour as needed. Max 64 sprays per day.

Week 9-10: 1-2 sprays every half hour as needed. Max 64 sprays per day.

Week 11+ or as needed for up to 6 months Nicorette oral formats can be used as required after the discontinuation of NICORETTE® Patch


Counselling: For patients who experience habitual cravings and need distraction. Encourage to take before cravings hit.

Week 1-6: Up to 20 pieces per day as needed

Week 7-8: Up to 20 pieces per day as needed

Week 9-10: Up to 20 pieces per day as needed

Week 11+ or as needed for up to 6 months Nicorette oral formats can be used as required after the discontinuation of NICORETTE® Patch


Counselling: For patients who experience habitual cravings and need a discreet way to manage. Advise to take lozenge before cravings start.

Week 1-6: Up to 15 lozenges per day as needed

Week 7-8: Up to 15 lozenges per day as needed

Week 9-10: Up to 15 lozenges per day as needed

Week 11+ or as needed for up to 6 months Nicorette oral formats can be used as required after the discontinuation of NICORETTE® Patch


Combination NRT is easily accessible for patients, with brands such as Nicorette readily available through pharmacies. Pharmacists are well versed in counselling on NRT use to support quit attempts.

NRT allows you the flexibility to engage with patients who may not be willing to give up smoking entirely. Patients can be advised to reduce their cigarette intake, using NRT as a substitute. Nicotine patches can be used two weeks before quitting to help prepare for a quit attempt.

NRT is not contraindicated in pregnancy. Ideally smoking cessation during pregnancy should be achieved without NRT. However, for women unable to quit on their own, NRT may be recommended to assist a quit attempt.2

In stable cardiovascular disease Nicorette products presents a lesser hazard than continuing to smoke. However dependent smokers currently hospitalised as a result of myocardial infarction, severe dysrrhythmia or cerebrovascular accident (CVA) and who are considered to be haemodynamically unstable should be encouraged to stop smoking with non-pharmacological interventions. If this fails, Nicorette products may be considered, but as data on safety in this patient group are limited, initiation should only be under medical supervision.2

Nicorette® is a stop smoking aid and contains nicotine. With a range of formats, it has been assisting smokers to quit for over 40 years with data from over 220 clinical trials.


References:

  1. The Royal Australian College of General Practitioners. Supporting smoking cessation: A guide for health professionals. 2nd edn. East Melbourne, Vic: RACGP, 2019.
  2. Nicorette® 16hr- Invisipatch PI. Available at: https://apps.medicines.org.au/files/pcpinvis.pdf