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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 4 - Central nervous system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
04.10.02 Nicotine dependence
NICE CKS Smoking cessation Last revised in August 2024 NICE guideline [NG209] 30 November 2021: Tobacco: preventing uptake, promoting quitting and treating dependence

Nicotine Replacement Therapy

GREEN
First Choice

 Restricted Item Prescribable only for patients who are willing to engage in a smoking cessation programme.

  • Chewing gum, sugar-free.

         2mg, 4mg.

  • Patches

         releasing approx. 10mg/16 hours;

         releasing approx. 15mg/16 hours;

         releasing approx. 25mg/16 hours.

         releasing approx. 7mg/24 hours;

         releasing approx. 14mg/24 hours;

         releasing approx. 21mg/24 hours.

  • Inhalator

          15mg/cartridge, 4 cartridge pack, 20 cartridge pack, 36 cartridge pack.

  • Lozenges, sugar free.

          2mg, 4mg.

  • Nasal spray

   nicotine 500 micrograms/metered spray

   10ml, 175-spray unit/100 doses.

  • Oral spray (Nicorette Quickmist® mouthspray)
   nicotine 1mg/metered dose

           13.2ml, 150 sprays.

 

Entry reviewed: December 2024

BNF BNFc SPC

Bupropion Hydrochloride (Zyban®)

GREEN
Restricted Drug Restricted
For use in accordance with the Luton & Dunstable Hospital's Trust Guidelines.

Restricted - to be prescribed on the recommendation of a smoking cessation specialist.
BNF BNFc SPC
MHRA Drug Safety Update (November 2020): risk of serotonin syndrome with use with other serotonergic drugs

Cytisinicline 1.5mg tablets / cytisine
(Smoking cessation)

GREEN
Restricted Drug Restricted

Approved for use to aid smoking cessation within its licensed indications as second line treatment option after Nicotine Replacement Therapy.

  • Smoking cessation teams will assess patients for suitability, fill in the agreed proforma, then write to the GP with a request to prescribe.
  • Primary care prescribers may also initiate if confident to do so.

Monitoring:

May cause hypertension therefore it is recommended that baseline and ongoing regular monitoring is undertaken for the duration of the course. Consider loan of blood pressure monitor for patients who do not already have their own machine.

 

See also Factsheet for prescribers

 

Entry reviewed: November 2024

BNF BNFc SPC

Varenicline
(500micrograms and 1mg tablets)

GREEN
Restricted Drug Restricted

Restricted - to be prescribed on the recommendation of a smoking cessation specialist. 

Patients should be advised to discontinue treatment and seek prompt medical advice if they develop agitation, depressed mood, or suicidal thoughts. Patients with a history of psychiatric illness should be monitored closely while taking varenicline.

Entry reviewed: November 2024

BNF BNFc SPC
NICE TA123: Varenicline
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.