The anti-smoking drug Zyban has been approved for NHS use - but only for smokers who have made a commitment to give up.

The National Institute for Clinical Excellence has issued guidance on Zyban, and nicotine replacement therapies (NRT) such as patches, chewing gum, lozenges and tablets. The guidance could cost the NHS in England and Wales, up to £50m a year. Smoking costs the NHS £1.5 billion a year. NICE says smokers must have a target date for when they will quit before NRT or Zyban can be prescribed. But NICE says advice and encouragement is also crucial to helping people stop smoking. They outline what doctors should take into account and discuss with their patients when prescribing treatments. NICE, which began its appraisal of smoking cessation therapies in December 2000, recommends a two week prescription for NRT and a three to four week prescription for Zyban (bupropion) - which smoker's need to start taking one week before their target date. But it says smokers should only be given a second prescription for NRT or Zyban if they can show they are still trying to stop. If smokers do not manage to give up, NICE recommends they should not be given another course of treatment for at least six months. There are estimated to be about 11m regular smokers in the UK. About 4m try to stop each year, but only three to six out of every 100 succeed. Half of all smokers die early because of smoking related illnesses. Commitment Anne-Toni Rodgers, executive director at NICE, said the treatments were one of the most cost-effective solutions available. "On average 300 people a day die as a result of smoking and each year the NHS spends about £1.5 billion treating smoking related illnesses. "Today's guidance means that the NHS will be supporting smokers who are motivated to quit with a choice of clinically and cost effective treatments. "The guidance also makes it clear that smokers have to be really committed to quitting and taking up the support and advice on offer and if they are unsuccessful, another course of treatment should not usually be prescribed within six months. "Doctors, in discussion with the patient, will decide which treatment will be the most appropriate to prescribe." Zyban acts on the brain to quash the craving nicotine tobacco products produce, and was hailed as a "wonder-drug" when it was launched in the UK two years ago. But there have since been concerns about the drug. There have been 58 deaths after suspected adverse reactions to Zyban, though the Medicines Control Agency said the link between the drug and the deaths was unproven. NICE says it will monitor the situation. It added the most clinically important side effect of Zyban was seizures, occurring in one in 1,000 patients. It adds smokers who are at risk of seizures must not be prescribed the drug, unless the benefits of stopping smoking outweigh the risks. Diabetics taking glucose-lowering drugs or insulin and people using anoretic (appetite suppressing) drugs are also at higher risk of seizures. Reduce disease burden Health campaigners have welcomed NICE's decision. Sir Paul Nurse, joint director-general of Cancer Research UK, said: "Today's announcement is good news for smokers. "A Cancer Research UK-funded survey has shown that 83% of smokers reported that they would not smoke if they had their time again. "This NICE guidance means greater access to proven cessation methods that will ultimately lead to more lives saved." He said: "Less money would need to be spent on treating diseases such as cancer if more was done to prevent people from developing them in the first place. "There is now no excuse for health authorities to refuse to prescribe these important cessation products. If properly implemented this guidance will help to noticeably cut tobacco deaths." Clive Bates, of Action for Smoking on Health, said: Clive Bates director of the anti-tobacco campaigning group Action on Smoking and Health said: "This should end any doubt or hesitation about prescribing these life-saving drugs that still persist in the NHS. "When a doctor treats smoking he or she is effectively tackling 50 different diseases before they can develop and that saves a lot of life and money in the long-term."

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