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Smoking Cessation

NICE guideline [NG209] Tobacco: preventing uptake, promoting quitting and treating dependence. Last updated: Feb 2025.

Guidelines

Available interventions
 
Category Specific intervention
Behavioural interventions
  • Behavioural support (individual and group)
  • Brief advice
Medicinally licensed products
  • Nicotine replacement therapy (gum / inhalator / lozenge / spray / sublingual tablet / transdermal patch)
  • Bupropion
  • Varenicline
  • Cytisinicline (cytisine)
Nicotine-containing e-cigarettes n/a
Allen Carr's Easyway in-person group seminar n/a
 

Advise on nicotine-containing e-cigarettes:

  • E-cigarettes are not licensed medicines but are regulated by the Tobacco and Related Products Regulations (2016)
  • Not enough evidence to know whether there are long-term harms from e-cigarette use
  • Use of e-cigarettes is less likely to be substantially less harmful than smoking
  • Any smoking is harmful, so people using e-cigarettes should stop smoking tobacco completely

NICE do not recommend any specific medications as 1st line, instead advise that the decision should be guided by 1) contraindications and adverse effects, 2) patient's preference, 3) previous experience with smoking cessation drugs.

 
Drug Contraindications Adverse effects
Nicotine replacement therapy No specific contraindications
  • Headache and dizziness
  • Nauses and vomiting
  • Rash and urticaria
  • Palpitations
  • Hyperhidrosis
Bupropion
  • <18 y/o
  • Current or history of seizures
  • Current of history of anorexia / bulimia
  • History of bipolar disorder
  • CNS tumour
  • Severe hepatic cirrhosis
  • Acute alcohol or benzodiazepine withdrawal
  • Psychiatric side effects
    • Insomnia (very common)
    • Anxiety
    • Agitation
    • Depression
  • Neurological side effects
    • Tremor
    • Concentration disturbance
    • Headache and dizziness
  • Non-specific side effects
    • Dry mouth
    • Nausea and vomiting
    • Abdominal pain
    • Constipation
    • Fever
    • Rash, pruritus
Varenicline
  • <18 y/o
  • End-stage renal disease
  • Psychiatric side effects
    • Abnormal dreams
    • Insomnia
    • Suicidal thoughts, hallucinations, aggression (uncommon)
  • GI side effects
    • Nausea and vomiting
    • Constipation, diarrhoea
    • Abdominal distension and discomfort
    • Dyspepsia
    • Flatulence
    • Toothache
    • Dry mouth
  • Cardiac side effects
    • Myocardia infarction
    • Angina pectoris
    • Palpitations
Cytisinicline 
  • <18 y/o or ≥66 y/o
  • Unstable angina / arrhythmias / recent myocardial infarction / recent stroke
  • Renal / hepatic impairment
  • Anxiety or mood alteration
  • Appetite change
  • Impaired concentration and fatigue
  • Constipation
  • Nausea and vomiting
  • Dizziness, drowsiness
  • Dry mouth
  • Headache
  • Myalgia
 
Drug Initiation timing Duration of treatment
Nicotine replacement therapy Start on quit date 8-12 weeks
Bupropion Start 1-2 weeks before quit date (i.e. start when the patient is still smoking) 7-9 weeks
Varenicline Start 1-2 weeks befor quit date (i.e. start when the patient is still smoking) 12 weeks
Cytisinicline Start 5 days before quit date (i.e. start when the patient is still smoking) 25 days

Measure carbon monoxide level 4 weeks after quitting
  • ≤10 suggests the person is not smoking

References

Author: Stella Panou
Reviewer:
Last edited: 31/07/25