General Practice

As part of the rollout of vaping reforms, from 1 July 2025 the Therapeutic Goods Administration (TGA) is implementing strengthened standards for all therapeutic vaping goods for smoking cessation and nicotine dependence. These include stricter requirements for ingredients, packaging and labelling. These stronger safety and quality standards are designed to mitigate certain risks associated with the use of therapeutic vapes. Pharmacies can only supply vapes that meet these new standards.

Read more.

Quit’s 3-step brief advice model for smoking and vaping cessation, Ask, Advise, Help (AAH) allows health professionals to quickly identify patients who smoke and/or vape and connect them to best practice treatment. AAH can be used at every clinically appropriate opportunity, using the following steps:

• Ask all patients about smoking and/or vaping status and document this in their medical record.
• Advise all patients who smoke and/or vape to quit in a clear, non-confrontational and personalised way, and advise how to quit (using the information on this page).
• Help by offering all patients who smoke and/or vape a referral to behavioural intervention through Quitline (quitcentre.org.au/referral-form), and by prescribing (or helping patients to access) pharmacotherapy if clinically appropriate.

Download the Ask, Advise, Help chart (PDF).

Most people who smoke and/or vape make several attempts to quit. Multi-session behavioural support, such as that offered at Quitline, supports people to plan, make, and sustain a quit attempt.

Quitline is a welcoming, confidential and evidence-based telephone counselling service based on established approaches such as cognitive behavioural therapy and motivational interviewing.

Quitline counsellors:

• assess a person’s smoking and/or vaping history and work with them to enhance motivation and develop and sustain a plan to stop smoking and/or vaping
• assess the person’s behaviours associated with smoking and/or vaping and provide tailored psychoeducation to support them in understanding and managing their withdrawal experiences, including mood monitoring and the use of pharmacotherapy.  
• support people in developing confidence to set and achieve goals, building skills to manage triggers and cravings, and adopt a new self-image, as a person who doesn’t smoke or vape.

Quitline counsellors are counselling professionals who use core counselling skills to engage the patient, and guide them through each call, working collaboratively toward treatment goals. GPs can partner with Quitline in providing best practice care. Making a direct referral to Quitline, rather than simply recommending your patient to call, increases the likelihood of that patients will access behavioural support in a quit attempt.

Download the infographic How Quitline helps patients to stop smoking and/or vaping (PDF).

Quitline is tailored to meet the needs of priority populations including patients living with mental illness, pregnant people and young people. Quitline also provides counsellors who are Aboriginal and/or Torres Strait Islander, and can assist people with hearing or speech impairment, or people needing an interpreter.

Smoking cessation

Smoking cessation pharmacotherapy can reduce the severity of cravings and withdrawal symptoms. People who are nicotine dependent can experience withdrawal symptoms on stopping, usually commencing within 24 hours of the last cigarette, and peaking over the first week, before steadily declining and disappearing over approximately 2–4 weeks. Indicators of nicotine dependence include smoking within 30 minutes of waking, smoking more than 10 cigarettes per day, and a history of withdrawal symptoms in previous attempts to quit.

Smoking cessation pharmacotherapies currently listed on the Australian Register of Therapeutic Goods (ARTG) include nicotine replacement therapy (NRT) (formulations include nicotine patch, gum, lozenge and mouth spray), varenicline and bupropion. These medications have been approved by the Therapeutic Goods Administration (TGA) for efficacy, safety and quality.

Learn more about the best smoking cessation pharmacotherapy for your patient, based on clinical suitability and reasons to prefer, using the flowchart in the practical guide for GPs (PDF).

Learn more about supporting smoking cessation in pregnancy and breastfeeding using the Supporting smoking cessation in pregnancy and breastfeeding - Guideline (PDF) developed in collaboration with The Royal Women's Hospital Pharmacy Department.

Nicotine Replacement Therapy (NRT)

NRT is effective. A Cochrane review published in 2023 concluded that studies of people who use single formulations of NRT show that they are about 1.4 times more likely to quit successfully compared with those in control conditions. Combination NRT (patch plus faster-acting formulation) leads to almost double quit rates. Long-term, people who use NRT are about twice as likely to stay quit four years later than those not using NRT.

There are different formulations of NRT:

• Transdermal – nicotine patch
• Faster-acting – nicotine gum, lozenge and mouth spray.

Nicotine patches are currently subsidised on the Pharmaceutical Benefits Scheme (PBS). All formulations of NRT can be accessed over the counter through pharmacies and supermarkets.

Varenicline

Varenicline at standard doses can more than double the likelihood of long-term quitting compared to using no pharmacotherapy. It is more effective than NRT monotherapy, has similar efficacy to combination NRT and is more effective than bupropion. Varenicline can be combined with NRT, and a second course of varenicline can be considered to prevent relapse.

Varenicline is currently subsidised on the PBS. Further information on varenicline can be found in the Royal Australian College of General Practitioners (RACGP) Supporting smoking cessation: A guide for health professionals (PDF).

Bupropion

Bupropion significantly increases quit rates compared to placebo. While it is not as effective as varenicline for smoking cessation, bupropion may be an option when varenicline is not appropriate (e.g. patient choice, side effects).

Bupropion is currently subsidised on the PBS. Further information can be found in the Royal Australian College of General Practitioners (RACGP) Supporting smoking cessation: A guide for health professionals (PDF).

Cytisine

Cytisine is a naturally occurring substance, chemically related to varenicline, that has been used for smoking cessation for decades in parts of Eastern Europe. Cochrane meta-analyses conclude that cytisine increases the chances of quitting, although absolute quit rates in two recent trials were modest.

Cytisine is not currently approved by the TGA. Lawful supply requires TGA approval under the Special Access Scheme Category B (SAS-B) or Authorised Prescriber Scheme.

Vapes

There are currently no approved vapes. This means that vapes have not been assessed by the TGA for safety, quality and efficacy, and their long-term health impacts remain unknown. 

Vapes that can be supplied by pharmacies are included in the Notified vape list which means they have been notified by a product sponsor to comply with quality standards. See TGA information for prescribers.

The RACGP recommendations include that, for people who have tried to achieve smoking cessation with first-line therapy (combination of behavioural support and TGA approved pharmacotherapy) but failed and are still motivated to quit smoking, vapes may be a reasonable intervention to recommend along with behavioural support. However, this needs to be preceded by an evidence-informed shared-decision making process.

Further information can be found in the RACGP Supporting smoking cessation: A guide for health professionals Guidance on smoking and vaping cessation support related to changes to Australia’s vaping regulation (PDF).

Vaping cessation

Indicators of nicotine dependence in people who vape include use within 5 minutes of waking (a very high level of dependence) and within 30 minutes of waking (a high level of dependence).

Evidence for the use of pharmacotherapies for vaping cessation is limited, especially in young people. If patients are over 18 years, pharmacotherapy options for which there is some evidence for use in vaping cessation, are NRT and varenicline. Pharmacotherapies that are TGA approved for smoking cessation are not approved for vaping cessation, therefore prescribing is off label.

The RACGP guidelines outline that the use of pharmacotherapy may be considered from age 12 if there are no contraindications. However, this is based on evidence from studies for smoking cessation. In patients aged 12-17 years, NRT is the preferred pharmacotherapy option for vaping cessation given the greater evidence of safety, in conjunction with behavioural support and counselling.

See further information, including eligibility for subsidised NRT for vaping cessation.

References

Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2. Accessed 29 July 2025.

Greenhalgh, EM, Scollo, MM and Winstanley, MH. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2024. Available from: https://www.tobaccoinaustralia.org.au/.
Accessed 27 March 2025.

Lindson N, Theodoulou A, Ordóñez-Mena JM, Fanshawe TR, Sutton AJ, Livingstone-Banks J, Hajizadeh A, Zhu S, Aveyard P, Freeman SC, Agrawal S, Hartmann-Boyce J. Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta‐analyses. Cochrane Database of Systematic Reviews 2023, Issue 9. Art. No.: CD015226. DOI: 10.1002/14651858.CD015226.pub2.
Accessed 10 July 2025.

Livingstone-Banks J, Fanshawe TR, Thomas KH, Theodoulou A, Hajizadeh A, Hartman L, Lindson N. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2023, Issue 6. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub9.
Accessed 29 July 2025.

The Royal Australian College of General Practitioners. Supporting smoking & vaping cessation: A guide for health professionals. Guidance on smoking and vaping cessation support related to changes to Australia’s vaping regulation. East Melbourne, Vic: RACGP; 2024. Available from: https://www.racgp.org.au/getmedia/924ba55d-dc47-41f9-bf5b-7a4cf9e19963/RACGP-NVP-and-Vaping-Cessation-September-2024.pdf.aspx. Accessed 1 April 2025.

The Royal Australian College of General Practitioners. Supporting smoking cessation: A guide for health professionals. 2nd ed. East Melbourne, Vic: RACGP; 2019. Available from: https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/supporting-smoking-cessation.
Accessed 27 March 2025.

Therapeutic Goods Administration. Vapes: Information for prescribers. Available from: https://www.tga.gov.au/products/unapproved-therapeutic-goods/vaping-hub/vapes-information-prescribers.
Accessed 27 March 2025.

Wilson, HK, Zwar, N. Assisting young people aged 12-25 years to cease e-cigarette use in general practice. Aust J Gen Pract. 2024 May; 53(5):311-316. Accessed 29 July 2025.

Clinically significant drug interactions occur with tobacco smoke. 

This Drug interactions with smoking table (PDF) table lists medications and drugs that require dosage adjustments when smoking is stopped. 

Patients’ smoking and/or vaping status should be regularly monitored and doses of relevant drugs adjusted accordingly.

Visit the Clinical Tools & Guidelines page for:

• Guideline: RACGP Supporting smoking cessation: a guide for health professionals (PDF)
• Guideline: Supporting smoking cessation in pregnancy and breastfeeding - general practice version (PDF)
• Helping patients to stop smoking: a guide for general practitioners (PDF)
• Brief advice model for smoking and vaping cessation (Ask, Advise, Help) chart (PDF)
• Nicotine Replacement Therapy (NRT) Tool
• Drug Interactions with Smoking table (PDF)
• Key message videos on talking to your patients with cardiovascular disease about smokingand talking to your patients with cancer about smoking

Visit the Events page for:

• Upcoming events such as webinars, podcasts and conferences
• Past events including recorded webinars such as the Australian Prescriber podcast: Therapeutic vapes for smoking cessation and nicotine dependence

Visit the Online Training page for:

• Quit online training modules for GPs on smoking and vaping cessation

Visit the Latest News and Research page for:

• News and announcements
• Relevant research in smoking and vaping cessation
• Quit Centre Quarterly newsletters.

Additional resources:

Visit Facts & Issues: Tobacco in Australia. A comprehensive review of the major issues on smoking and health in Australia, compiled by Cancer Council Victoria.