Smoking Cessation Interventions

Smoking Cessation Interventions; Pharmacological Aids

The US clinical guidelines ⁽⁴⁾ recommend use of NRT with caution in those within two weeks post-myocardial infarction, those with serious arrhythmias and those with worsening angina. Dependency • The UK guidelines recommend NRT or bupropion for people who smoke 10 cigarettes or more ⁽⁵⁾. The US and Scottish guidelines recommend that all smokers be offered appropriate pharmacotherapy, with NRT or bupropion as a first choice unless contraindicated ⁽⁴⁾. Pregnancy The US ⁽⁴⁾, UK ⁽⁵⁾ and Scottish ⁽¹²⁾ guidelines cautiously recommend NRT when a pregnant woman is otherwise unable to quit and when the likelihood of quitting, with its potential benefits, outweighs the risk of NRT use or continued smoking. A small non-random trial of nicotine patch use by pregnant women beyond 24 weeks found no adverse effect on fetal status ⁽¹³⁾. Availability of NRT NRT is currently available in the form of nicotine patch (7mg, 14mg and 21mg strength) which is available without prescription from pharmacists. This provides smokers with an opportunity to receive advice from pharmacists at the point of purchase. Barriers to access should be reviewed and addressed. The UK recently elected to make NRT available through a wider range of retail outlets and settings (ie not restricted to pharmacies). Saudi Arabia should consider this also. Proponents of wider distribution outlets for NRT argue that it should be as readily available as cigarettes themselves and more accessable to smokers wanting to quit.		There is no subsidisation of the cost of NRT for consumers in Saudi Arabia . A smoker using the patch for 10 weeks (an average course) will incur a cost of approximately 600 SR. This is comparable for many smokers to the cost of purchasing cigarettes over the same period. If NRT is made available at a reduced cost , the use of NRT will increase, where there is evidence to suggest that reducing out-of-pocket costs for NRT increases both use of NRT therapies and cessation outcomes ⁽¹⁴⁾. Anti-depressants Bupropion SR; is a non-nicotine aid to smoking originally developed and marketed as an anti-depressant. It is sold as Zyban in USA, UK and Australia. It blocks the re-uptake of dopamine and norepinephrine centrally. Use of bupropion SR approximately doubles cessation rate compared to placebo (30.5%, (95% CI 23.2, 37.8) versus 17.3% (15). When used for smoking cessation bupropion is initiated one to two weeks before the target quit date and is generally continued for three months. Bupropion is contra-indicated in people with a seizure disorder, a current or prior diagnosis of anorexia nervosa or bulemia, use of a monoamine oxidase (MAO) inhibitor within the previous 14 days or using other medications that contain bupropion. Nortriptyline is a tricyclic antidepressant that blocks uptake of norepinephrine and serotonin .Use of nortriptyline is estimated to triple smoking abstinence rates at five months or more compared to placebo cessation rate 30.1% (95% CI 18.1, 41.6) versus 11.7% ⁽¹⁵⁾.

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