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Varenicline (Champix) to help quit smoking

Using varenicline (trade name Champix) together with other kinds of support can increase the chances of quitting smoking. But this drug also very often has side effects.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 18, 2011

Can nicotine receptor partial agonists, including cytisine, dianicline and varenicline, help people to stop smoking?

When people stop smoking they experience cravings to smoke and unpleasant mood changes. Nicotine receptor partial agonists aim to reduce withdrawal symptoms and smoking satisfaction. Two recent trials of cytisine (937 people) confirm that it can be an effective and affordable treatment for smoking cessation. Quit rates were low, however, at around 9% in the treatment groups. The rate might be boosted in future studies by longer treatment and more intensive or extended counselling.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Quitting smoking aids

Most people who smoke decide to quit at some time or another. Yet it is often difficult to act on this decision. It usually takes several attempts until they are able to go without tobacco. There are a number of strategies that can help you to quit smoking.If you would like to quit smoking, there are different things you can try out to kick the habit. Around half of those who try to quit smoking don't need any extra help.  Many people receive important support from their partner, friends or family. Another option is to get advice on quitting smoking from a doctor or a pharmacist. Nicotine replacement therapy (NRT) and certain medications can help you break your nicotine addiction and deal with withdrawal symptoms.Maybe it also helps to think about how much money you can save by not smoking. You can find out how much money you personally spend on cigarettes by using our cigarette calculator. Setting personal goals can also be a good motivation, for example rewarding yourself for not smoking for a month with a nice meal or some new clothes.There are lots of brochures, materials and online offers that provide support for people who want to quit smoking, for example the www.rauchfrei-info.de (in German) website from the German Federal Center for Health Education (BZgA). Stop smoking courses are also available. Some health insurers cover part of the costs of such courses.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 26, 2014

Can I maintain my weight when I quit smoking?

More physical exercise might be the best way to maintain your weight when quitting smoking. Further research is needed to be able to say what the best methods are to avoid putting on weight when quitting smoking.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 10, 2012

Medications to help people to stop smoking: an overview of reviews

Smoking is a main cause of early death throughout the world. There are a number of medications which can help people to quit smoking. Three of these, nicotine replacement therapy (NRT), bupropion and varenicline, are licensed for this purpose in the USA and Europe. Cytisine (similar to varenicline) is licensed for use in Russia and Eastern Europe. We reviewed studies of these and other treatments, including nortriptyline, to compare their benefits and risks.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Are there any effective interventions to help individuals with schizophrenia to quit or to reduce smoking?

People with schizophrenia are very often heavy smokers. It is uncertain whether treatments that have been shown to help other groups of people to quit smoking are also effective for people with schizophrenia. In this review, we analysed studies which investigated a wide variety of interventions. Our results suggested that bupropion (an antidepressant medication previously shown to be effective for smoking cessation) helps patients with schizophrenia to quit smoking. The effect was clear at the end of the treatment and it may also be maintained after six months. Patients who used bupropion in the trials did not experience any major adverse effect and their mental state was stable during the treatment. Another medication, varenicline (a nicotine partial agonist which has been shown to be an effective intervention for smoking cessation in smokers without schizophrenia), also helps individuals with schizophrenia to quit smoking at the end of the treatment. However, this evidence is only based on two studies. We did not have sufficient direct evidence to know whether the benefit of varenicline is maintained for six months or more. In addition, there has been ongoing concern of potential psychiatric adverse events including suicidal ideas and behaviour among smokers who use varenicline. We found that two patients, among 144 who used varenicline, had either suicidal ideas or behaviour. Smokers with schizophrenia who receive money as a reward for quitting may have a higher rate of stopping smoking whilst they get payments. However, there is no evidence that they will remain abstinent after the reward stops. There was too little evidence to show whether other treatments like nicotine replacement therapy and psychosocial interventions are helpful.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Are there ways to help people stop using smokeless tobacco

Nicotine replacement therapy (patches or gum), and bupropion have not been shown to help people to stop using smokeless tobacco (ST). However, one study shows that varenicline can help people stop. Dentists and hygienists may help their patients to stop, especially when they show them the damage that ST causes in their mouths. Telephone counselling may assist ST users in quitting.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Can people be helped to stop smoking before they have surgery?

Smoking is a well‐known risk factor for complications after surgery. Stopping smoking before surgery is likely to reduce the risk of complications. We reviewed the evidence about the effects of providing smoking cessation interventions to people awaiting surgery on their success in quitting at the time of surgery and longer‐term, and at complications following surgery. The evidence is current to January 2014.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Do any interventions help smokers who have successfully quit for a short time to avoid relapsing?

Some people start smoking again shortly after quitting and are said to have 'relapsed'. Interventions used to help people avoid relapse usually focus on teaching the skills to cope with temptations to smoke. This approach and others have not been shown to be helpful, either for people who quit on their own or with the help of treatment, or for those who quit because they were pregnant or in hospital. Many trials conducted so far have not been of a strong enough design to detect possible small effects. Among drug treatments, extended use of varenicline may help some smokers. Studies of extended use of nicotine replacement treatment are urgently needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Drug treatments for stopping smoking in pregnancy

Smoking during pregnancy is a widespread health problem that causes much harm to women and their infants. Adverse pregnancy outcomes include miscarriage, preterm birth (less than 37 weeks' gestation) and low birthweight (less than 2500 g) babies. Tobacco smoking is associated with low socioeconomic status and those women who continue to smoke during pregnancy generally have lower incomes; lower levels of social support; more limited education; and are without a partner or with a partner who smokes. Women in several indigenous and ethnic minority groups are also more likely to smoke during pregnancy, as are women who are depressed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Does more support increase success amongst people using medications to quit smoking?

Medications (including all types of nicotine replacement therapy, bupropion and varenicline) have been shown to help people quit smoking. It has been unclear how much additional benefit is gained from also providing behavioural support, such as counselling or a telephone quitline. Combined results from 38 trials suggests that increasing the amount of behavioural support (in person or via telephone) increases the chances of quitting smoking for the long term by about 10 to 25%. The effect may be a little greater when adding some support compared to no support, and a little smaller when more support is compared to some support. Providing some personal contact is beneficial, and people making a quit attempt with pharmacotherapy will increase their chances of success of they also have access to behavioural support.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Interventions for preventing weight gain after smoking cessation

When giving up smoking, most people put on weight. Many smokers are concerned about this and say it may put them off making an attempt quit. Some studies show that weight gain also leads to people resuming smoking after an initially successful quit attempt. On the other hand, there are good reasons to believe that trying to limit weight gain may reduce the chance of stopping smoking. Several drug and behavioural programmes to limit post cessation weight gain have been tested. Of the drug treatments, naltrexone showed the most promise, but there were no data on its effects on weight once drug treatment stopped and there was not enough evidence to judge its effects on long term quitting. Weight management education alone did not limit weight gain and may undermine cessation. Weight management education with personalised support giving feedback on personal goals and a personal energy prescription limited weight gain and there was no evidence that it undermined cessation. Intermittent use of a VLCD improved cessation success and weight gain in the short term but not in the longer term.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Do medications used to treat depression help smokers who are trying to quit

Some medications and supplements that have been used to treat depression (antidepressants) have been tested to see whether they also help people who are trying to stop smoking. Two antidepressants, bupropion (Zyban) and nortriptyline, are sometimes prescribed to help with quitting smoking. This review set out to determine if using antidepressants increased people's likelihood of successfully quitting smoking at six months or longer and to determine the safety of using these medications to help quit smoking.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Does a combination of smoking cessation medication and behavioural support help smokers to stop?

Behavioural support (such as brief advice and counselling) and medications (including varenicline, bupropion, and nicotine replacement therapies like patches or gum) help people quit smoking. Many guidelines recommend combining medication and behavioural support to help people stop smoking, but it is unclear if some combinations are more effective than others, or if the combination of medication and behavioural support works better in some settings or groups than in others.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Bupropion to help quit smoking

People who want to quit smoking can increase their chances of short-term success by taking bupropion. But side effects are common, especially difficulty sleeping.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 26, 2014

Interventions started during hospitalisation to help people to stop smoking

Smoking contributes to many health problems including cancers, cardiovascular disease and lung diseases. Smoking also increases the risk associated with hospitalisation for surgery. People who are in hospital because of a smoking‐related illness are likely to be more receptive to help to give up smoking. Our review of fifty trials found that effective programmes to stop smoking are those that begin during a hospital stay and include counselling with follow‐up support for at least one month after discharge. Such programmes are effective when administered to all hospitalised smokers, regardless of the reason why they were admitted to hospital, and in the subset of smokers who are admitted to hospital with cardiovascular disease. Adding nicotine replacement therapy to a counselling program increases the success rate of a program for hospitalised smokers.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Smoking in Cancer Care (PDQ®): Patient Version

Expert-reviewed information summary about the influence of continued smoking on cancer treatment and risk of second cancers. Interventions to encourage smoking cessation are also discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: June 27, 2014

Smoking: Overview

Most people who smoke try to quit at some point. There are lots of good reasons to do so. But it is often difficult to act on this decision. There are a number of strategies that can help you kick your nicotine addiction.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 25, 2013

Can parents influence whether or not their children start smoking?

Many parents would like to prevent their children from starting to smoke. There are a number of suggestions of what might help, but there is not yet enough research on what might successfully keep children from starting to smoke. Whether or not a young person takes up smoking depends on their own attitude and the influence of their peers.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 18, 2013

Smoking: How much do nicotine patches and gum help?

Nicotine replacement products increase the chances of quitting smoking, but it usually takes more than one attempt.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 25, 2013

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