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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