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Zyban NRT

VIEWS: 25 PAGES: 1

									SMOKING CESSATION GUIDELINES FOR GREATER GLASGOW
                          Patient identified as requiring help to stop smoking


        INITIAL REVIEW: Considerations:                                                                   Suggest
        • Motivation to stop smoking?                                                                 information on
           ! Does the patient have the incentive and the motivation to stop?                             improving
           ! Does the patient have the confidence to give up?                                          motivation &
        • Nicotine dependence? (e.g. smokes first cigarette within 20 minutes of waking)                confidence
        • Willingness to stop smoking immediately (NRT) or within 2 weeks (Zyban®)?                      (Smoking
                                                                                                         Concerns)
                                                                                             NO
                                                  YES
    •     Medically suitable for NRT or amfebutamone (rINN = bupropion = Zyban®)?
                                                                                                 NO
    •     Aged > 16 years (some NRT) or over 18 years (Zyban® and most NRT)?
    •     Patient wishes pharmacological treatment?
    •     Interval of greater than 12 months since last course of treatment on NHS?
                                                                                             Consider advice on
                                                  YES                                        other treatment options
                                                                                             (Smoking Concerns)
                       • Consider medical treatment options
ZYBAN®                 • See checklists overleaf and SPC for details
                                                                               NRT

                                                  •   Exclude any C/I and note cautions
•    See checklist overleaf for C/I,              •   Review product choice, form, strength
     cautions, interactions, ADR                  •   Discuss treatment duration and instalment dispensing


ZYBAN® PRESCRIBING                                                NRT PRESCRIBING
# Prescribe 60 tablets (1 OP)                                     # Prescribe sufficient for 1 month of therapy
# Instruct ‘Dispense weekly’                                      # Instruct ‘Dispense weekly’
# Normal dose 150mg daily for 6 days, increasing                  # Dose is influenced by level of nicotine
  to 150mg twice daily (see exceptions attached)                    dependence
# Review at 1 month                                               # Review at 1 month



                                  Zyban® or NRT should only be prescribed in
                                  combination with smoking cessation advice and support.


                                REVIEW PATIENT SUPPORT SYSTEM
Options for support in Greater Glasgow include:
• Pharmacies in the GGHB Smoking Cessation programme who are formally accredited to provide advice,
   information and CO monitoring (see attached or www.show.scot.nhs.uk/gghbpharmacy)
• Services available within your LHCC or General Medical Practice



                 1 MONTH REVIEW                                            •    Review progress and side effects
NO                                                          YES
                 Has Patient Stopped Smoking ?                             •    Prescribe 2nd month’s supply if req’d


DISCONTINUE THERAPY                         ZYBAN®                                   NRT
With immediate effect for NRT but           - Note CSM reporting of ADR              - Normal course is 8 weeks
allow another 3 weeks for Zyban.            - Maximum course is 7-9 weeks            - Some may need longer course

								
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