Simon Lister
Service Manager
Rotherham Stop Smoking Service
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To provide an outline of the NRT voucher
scheme (issuing the voucher and dispensing
the product)
Provide an overview of the products available
Please note: there will be two NRT voucher
schemes operating in Rotherham – SWYPFT
and TRFT
Clients must be:
1. Registered with a Rotherham or Doncaster
GP
2. Aged12 or over
3. Have set a quit date (must be attending
support sessions with DRSFS or third party
provider)
1.
2.
3.
4.
5.
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Unstable angina, Myocardial Infarction (heart attack) or
abnormal heart rhythm within the last 2 weeks
A stroke or transient ischemic attack (TIA or mini-stroke)
within the last 2 weeks
Hyperthyroidism (over active thyroid) not controlled by
medication
Phaeochromocytoma (rare tumour of the adrenal gland)
Does the client take clozapine (Clozaril, Denzapine,
Zaponex) ropinirole (Requip), theophylline (Nuelin SA, SloPhyllin, Uniphyllin Continus) or aminophylline
If clients answer YES to any of the above they are not
eligible for NRT via this scheme
Currently not possible to refer clients who meet the
exclusion criteria to GP for NRT as before.
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The Stop Smoking Advisor (Specialist Service or
LES) will complete the first 3 sections of the
voucher – client details, advisor details & request
the product, strength, quantity and supply number.
The dispensing pharmacist must complete the date
of supply, inclusion/exclusion criteria, client
consent and sign the voucher at the bottom of the
form.
DRSFS have produced an SOP for completing the
voucher although not valid in your organisation it
can be used as a template.
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Explain that nominally one product will be issued via the
voucher.
Combination therapy is only available in exceptional
circumstances - defined as a score of 11 in the Doncaster
and Rotherham Smoke Free Services Client Triage Algorithm
(see handout)
Discuss and agree the choice of product(s), how to use them
and possible side effects.
Advise the client to read the product information leaflet prior
to commencement of treatment.
Complete the first 3 sections of the voucher (see handout),
i.e. the client details, the advisor details and the
product/dose and quantity
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Advise clients to buy the ‘step down’ patch/s or a supply of a
second product to support their quit attempt where
appropriate.
Vouchers will be issued on a weekly basis for the first 4
weeks and thereafter on a fortnightly basis to a maximum
total of 8 weeks (i.e. a maximum of 6 vouchers per client).
Issue the top 2 copies of the voucher (buff and yellow copies)
to the client and retain the bottom pink copy for record
keeping purposes, vouchers cannot be issued to a client
representative.
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Vouchers can be redeemed at participating pharmacies (to be
confirmed) in Doncaster or Rotherham only and the products
will be supplied under the supervision of a pharmacist.
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Nicorette invisi patch 25mg &15mg & 10mg.
NiQuitin patch 21mg & 14mg & 7mg
Nicotinelle patch 21mg & 14mg & 7mg
Nicorette gum 2mg & 4mg.
Nicorette Quickmist 1mg/spray
Nicorette Inhalator 15mg
NiQuitin Minis 1.5mg & 4mg
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NRT works by providing a ‘clean’ replacement for the nicotine
smokers would normally get from cigarettes/reduces the
cravings and other withdrawal symptoms.
Step down programme - gradually wean off
NRT doubles your chance of quitting, however it is not a cure
– need to manage unrealistic expectations
Combination therapy (patch + oral product) is more effective
than a single product.
Nominally only one product is available on the voucher remember to advise the client to buy the second product and
the step down products.
There is no evidence for the effectiveness of combining NRT
with Varenicline (Champix), therefore it is not to be
recommended.
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Available in: 25mg, 15mg, 10mg
If smoking 10 or more cigs/day start on 25mg,
If less than 10cigs/day start on 15mg
Usual regime: 25mg for 8 weeks, followed by 15mg
for 2 weeks, followed by 10mg for 2 weeks
Apply one patch per day (on waking), to any hair
free, dry patch of skin. Take off at bedtime.
Advantage: provides sustained levels of
background nicotine, is discrete & easy to use.
Disadvantage: can cause local irritation, not
possible to titrate dose. Slow acting
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Available in 3 dose’s – 21mg, 14mg, 7mg
If smoking 10 or more cigs/day start on 21mg,
If less than 10cigs/day start on 14mg
Usual regime: 21mg for 6 weeks, followed by 14mg
for 2 weeks, followed by 7mg for 2 weeks
Apply one patch per day (on waking), to any hair
free, dry patch of skin.
Advantage: provides sustained levels of
background nicotine, is discrete & easy to use.
Disadvantage: can cause local irritation, not
possible to titrate dose. Slow acting
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Available in 3 dose’s – 21mg, 14mg, 7mg
If smoking 20 or more cigs/day start on 21mg,
If less than 20cigs/day start on 14mg
Usual regime: 21mg for 4 weeks, followed by 14mg
for 4 weeks, followed by 7mg for 4 weeks
Apply one patch per day (on waking), to any hair
free, dry patch of skin.
Advantage: provides sustained levels of
background nicotine, is discrete & easy to use.
Disadvantage: can cause local irritation, not
possible to titrate dose. Slow acting
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Available in: 2mg & 4mg
If smoking 20 or more cigs/day take 4mg
If less than 20cigs/day start take 2mg
Maximum 15 pieces/day
Take up to 15 pieces/day for first 4-6 weeks then
gradually cut down to zero.
Chew until taste the flavour then ‘park’ between
cheek and gum until flavour recedes than repeat.
Advantage: easy to titrate dose, available in several
flavours
Disadvantage: some clients do not like the taste,
difficult with dentures, may cause local irritation
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Available in single 13.2 ml dispenser and duo pack ( 2 x
13.2ml). Each spray contains 1mg of nicotine
Use 1-2 sprays every 30 minutes to 1 hour (maximum 64
sprays in 24 hours).
Use as above for first 4-6 weeks then gradually cut down to
zero
After priming, point the spray nozzle as close to the open
mouth as possible. Press the top of the dispenser and release
one spray into your mouth, avoiding the lips. Do not inhale
while spraying to avoid getting spray down your throat. For
best results, do not swallow for a few seconds after spraying.
Advantage: fact acting, easy to titrate
Disadvantage: some clients do not like the taste, may cause
local irritation
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Available in 15 mg cartridges (20 and 36 pack size
– each pack contains one inhalator mouthpiece)
Use up to 6 cartridges/day
Nicorette Inhalator should be used whenever the
urge to smoke is felt or to prevent cravings in
situations where these are likely to occur.
Each cartridge lasts for approximately eight 5minute sessions, but change when can no longer
taste the nicotine
Advantages: fact acting, easy to titrate
Disadvantages: some clients do not like the taste,
may cause local irritation
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Available in: 1.5mg & 4mg
If smoking 20 or more cigs/day take 4mg
If less than 20cigs/day start take 1.5mg
Use up to 15 lozenges/day
One lozenge should be placed in the mouth and
allowed to dissolve. Periodically, the lozenge
should be moved from one side of the mouth to
the other, not be chewed or swallowed whole
Advantages: fact acting, easy to titrate
Disadvantages: some clients do not like the taste,
may cause local irritation.
Any questions?
Thank you for
listening