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Can nicotine receptor partial agonists, including cytisine 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 these withdrawal symptoms and the pleasure people usually experience when they smoke. The most widely‐available treatment in this drug type is varenicline, which is available world‐wide as an aid for quitting smoking. Cytisine is a similar medication, but is only available in Central and Eastern European countries and through internet sales.

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

Version: 2016

Quitting smoking: Things that can help

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

What is the best way to help people with chronic obstructive pulmonary disease stop smoking?

We wanted to find out the best way to help people with chronic obstructive pulmonary disease (COPD) to stop smoking.

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

Version: 2016

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

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

Drug treatments for stopping smoking in pregnancy

Smoking during pregnancy harms women and infants. Women who continue to smoke during pregnancy generally are poorer and more poorly educated and are more likely to have no partner or have a partner who smokes.

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

Version: 2016

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

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: 2016

Ways to help people stop using smokeless tobacco (including chewing tobacco, snuff and snus)

Smokeless tobacco is any product in which tobacco is held in the mouth so that nicotine is absorbed through the lining of the mouth. Smokeless tobacco is less dangerous than cigarettes and other products where tobacco is burnt and nicotine absorbed through the lungs. However, smokeless tobacco still leads to nicotine addiction and can be harmful, especially to the mouth. Many types of smokeless tobacco are used around the world, including chewing tobacco, snuff and snus. The risks to health vary with the type of product.

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

Version: 2015

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

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, and people seeking help to quit smoking will frequently be offered medication (pharmacotherapy). Behavioural support also helps people to quit. Behavioural support may include brief advice or more intensive counselling, and may be provided face‐to‐face individually or in groups, or by telephone, including 'quitlines'. It has been unclear how much additional benefit is gained from adding support, or providing more intensive support for people who are using medication for a quit attempt.

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

Version: 2015

Does a combination of stop smoking 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: 2016

Can smokers be helped to reduce the harm caused by cigarette smoking by smoking fewer cigarettes or using different tobacco products?

The best thing to do to reduce the harms caused by smoking is to quit, but some people may not want to do this or may feel that they are unable to stop smoking completely. Cutting down the number of cigarettes smoked daily or using different tobacco products, such as chewing tobacco or low‐tar cigarettes, may reduce some of the harm caused by smoking. It may also help people to stop smoking completely in the long term. On the other hand, reducing smoking or using other tobacco products may not improve health and could reduce a person's motivation to quit smoking altogether. It is important that we review the evidence to find out whether these approaches could help smokers who do not want to or cannot quit to reduce the harm caused by their smoking. We were mainly interested in whether these approaches improved the health of smokers, but also looked at smoking reduction and quitting rates.

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

Version: 2017

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

Can we increase adherence to medications that help smokers to quit?

Medications that help people to stop smoking such as nicotine replacement therapy (NRT) are safe and effective treatments for smoking cessation. However, people often do not take the medication they are prescribed as they should. In the current review, we examined whether there are effective approaches to increasing adherence to these treatments, which should improve smokers' chances of quitting. These approaches, or interventions, typically involve providing additional information about the medication and helping people to overcome any problems they have in taking it as prescribed.

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

Version: 2015

Cigarette Smoking: Health Risks and How to Quit (PDQ®): Patient Version

Expert-reviewed information summary about research and guidelines focused on the prevention and cessation of cigarette smoking.

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

Version: December 16, 2016

Treatment for speech disorder in Friedreich ataxia and other hereditary ataxia syndromes (inherited disorders of movement co‐ordination)

We reviewed the evidence about the effects of treatment on speech difficulties in people with Friedreich ataxia and other hereditary ataxias.

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

Version: 2014

Interventions to help people living with HIV and AIDS to stop using tobacco

Background: Tobacco use is common amongst people living with HIV and AIDS (PLWHA); it causes a range of health problems and accounts for many deaths. There is good evidence about interventions to help people quit tobacco use in the general population, however the effectiveness in PLWHA was not known.

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

Version: 2016

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