NICE guidance - use of nicotine replacement therapy (NRT) , cytisinicline, varenicline and bupropion for smoking cessation

Summary points of the NICE guidance include:

• offer cytisinicline, NRT, varenicline or bupropion, as appropriate, to people who are planning to stop smoking
• offer advice, encouragement and support, including referral to the NHS Stop Smoking Service, to help people in their attempt to quit
• cytisinicline, NRT, varenicline or bupropion should normally be prescribed as part of an abstinent-contingent treatment, in which the smoker makes a commitment to stop smoking on or before a particular date (target stop date)
  • For adults, prescribe or provide bupropion, cytisinicline, NRT or varenicline before they stop smoking, and for:
    • bupropion, agree a quit date set within the first 2 weeks of treatment and reassess the person shortly before the prescription ends
    • cytisinicline, agree a quit date set within the first 5 days of treatment and reassess the person shortly before the prescription ends
    • NRT, agree a quit date and ensure the person has NRT ready to start the day before the quit date
    • varenicline, agree a quit date and start the treatment 1 to 2 weeks before this date; reassess the person shortly before the prescription ends
• consider NRT for young people aged 12 and over who are smoking and dependent on tobacco
  • if this is prescribed, offer it with behavioural support
• do not offer cytisinicline, varenicline or bupropion should be offered to young people under 18 nor to pregnant or breastfeeding women
• do not offer cytisinicline to people aged 66 and over
• do not offer NRT, varenicline or bupropion in any combination
• advise people (as appropriate for their age) that the following options, when combined with behavioural support, are more likely to result in them successfully stopping smoking:
  • cytisinicline
  • a combination of short-acting and long-acting NRT
  • varenicline
  • nicotine-containing e-cigarettes

Notes

• cytisinicline is sometimes referred to as cytisine

Reference:

• (1) NICE (February 2025). Tobacco: preventing uptake, promoting quitting and treating dependence. www.nice.org.uk