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Smoking Cessation
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> Bupropion - may cause seizures - avoid in epilepsy ''NICE (2008)'' offer NRT, varenicline or bupropion as part of cessation programme with target stop date only give for 2-4/52 (2 - NRT, 3-4 VorB) if not successful - do not repeat for 6/12 do not combine drugs ''Nicotine Replacement Therapy (NRT)'' SE - n&v headache, flulike Sx if still smoke lots / failed in past - offer patches and other from (gum, lozenge, spray) ''Varenicline'' Nicotinic receptor partial agonist start 1/52 before stop date and continue about 12/52 (so long as still not smoking) more effective than bupropion SE - nausea also headache, insomnia, abN dreams beware if Hx depression or self harm CI in pregnancy or breast feeding ''Bupropion '' Norepinephrine and dopamine reuptake inhibitor and nicotinic antagonist start 1-2/52 before stop date 1 in 1000 fit CI - epilepsy, pregnancy, breast feeding (and relatively an eating disorder) ''Pregnant women'' NICE 2010 recommend all women should be tested with CO detector all who smoke, hav stopped within 2/52 or have CO reading >7ppm - refer Interventions 1st line - CBT, motivational interviewing, structured self help and support NRT used 2nd line - evidence mixed on effectiveness DON'T use VorB
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