Pharmacy

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 and confidential 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, and building skills to manage triggers and cravings, and to 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. Pharmacists 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 that patients will access behavioural support in a quit attempt.

Download the How Quitline helps patients to quit smoking and/or vaping infographic (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 last smoking, and peaking over the first week, before steadily declining and disappearing over approximately 2–4 weeks. 

Indicators of nicotine dependence in people who smoke 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 supporting smoking cessation in pregnancy and breastfeeding using this 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 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.

Learn more about supporting smoking cessation in pregnancy and breastfeeding (PDF) developed by Quit in collaboration with the Royal Women's Hospital Pharmacy Department.

Pharmacists supporting Aboriginal and Torres Strait Islander people who smoke (PDF). A resource for pharmacists which includes suggested ways of yarning about nicotine replacement therapy (NRT). Developed in collaboration with the PSA.

Videos outlining how to use each formulation of NRT

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.

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.

Cytisine

Cytisine is currently used overseas for smoking cessation. A Cochrane meta-analysis concludes that cytisine increases the chances of quitting, although absolute quit rates in two recent trials were modest.

Cytisine is an unapproved product in Australia and is only available under the Special Access Scheme Category B (SAS-B) or Authorised Prescriber (AP) 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 pharmacists.

The current evidence for the use of nicotine vapes for smoking cessation is uncertain.

The PSA recommends that nicotine vapes are not a first line option for smoking cessation and may be considered for patients who have failed to stop smoking with first-line pharmacotherapy (TGA approved pharmacotherapy in combination with behavioural support eg Quitline). The decision to use vapes as an unapproved treatment must be made through an evidence-informed shared decision-making process with the patient.

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.

References

PSA. Professional Practice Guidelines for Pharmacist: Nicotine dependence support. Professional practice guidelines for pharmacists: Nicotine dependence support - Pharmaceutical Society of Australia.
Accessed 6 May 2025.  

Facts & Issues: Tobacco in Australia. https://www.tobaccoinaustralia.org.au/.
Accessed 6 May 2025   

Greenhalgh, EM, Dean, E, Stillman, S and Ford, C. 7.16 Pharmacotherapies for smoking cessation. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2024. Available from: https://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-16-pharmacotherapy .
Accessed 6 May 2025. 

RACGP. Supporting smoking and vaping cessation.  https://www.racgp.org.au/getmedia/924ba55d-dc47-41f9-bf5b-7a4cf9e19963/RACGP-NVP-and-Vaping-Cessation-September-2024.pdf.aspx . 
Accessed 6 May 2025.  

RACGP. Supporting smoking cessation: A guide for health professionals. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/supporting-smoking-cessation#:~:text=What%20is%20new%20-%20Guidance%20updates%20on.
Accessed 27 March 2025.  

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.

Vapes for the management of smoking cessation or nicotine dependence can only be sold at participating pharmacies. This applies to all vapes, including those that do not contain nicotine.  

From 1 October 2024, people 18 years and older can buy vapes with a nicotine concentration of 20 mg/mL, or less from certain pharmacies without a prescription where state and territory laws allow. A prescription from a medical or nurse practitioner is required for nicotine concentrations greater than 20 mg/mL. 
Read more.  

Reference 

Therapeutic Goods Administration. Vapes: Information for pharmacists 2024 Vapes: information for pharmacists | Therapeutic Goods Administration (TGA).
Accessed date 6 May 2025. 

Clinically significant drug interactions occur with tobacco smoke.

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

Patients should be regularly monitored with regard to their smoking and/or vaping status and doses of relevant medicines adjusted accordingly.

More information about pharmacotherapy drug interactions can be found in PSA: Professional practice guidelines for pharmacists: nicotine dependence support (PDF).

Visit the Clinical Tools & Guidelines page for resources including:   

• Brief advice model for smoking and vaping cessation (Ask, Advise, Help) chart (PDF)  
• Interactive Nicotine replacement therapy (NRT) tool 
• Drug interactions with smoking table (PDF)  
• Guideline: PSA Professional practice guidelines for pharmacists: nicotine dependence support (PDF)) 
• Pharmacists supporting Aboriginal and Torres Strait Islander people who smoke (PDF)  
• Guideline Supporting smoking cessation in pregnancy and breastfeeding (Health Service version)  
• Videos outlining how to use each formulation of NRT 

Visit the Events page for:  

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

Visit the Online Training page for: 

• Quit online training modules for pharmacists 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:

Tobacco in Australia - Facts & Issues: a regularly updated online resource of the major issues in smoking and health in Australia, compiled by Cancer Council Victoria. 
Home Page - Tobacco in Australia