Cytisine

What is Cytisine?

Cytisine is both the generic and brand name of the product available in the UK for quitting smoking. Cytisine is an alkaloid which is naturally found in many plants and seeds, particularly Laburnum seeds. It is a partial agonist on the alpha-4 beta-2 nicotinic acetylcholine receptor, which plays an important role in nicotine addiction. So, cytisine works by mimicking the actions of nicotine to help you give up smoking.

Cytisine is not a new drug but has not been available in the UK until recently. It was first developed in the early 1950s. It has been sold under the brand name Tabex since the 1970s in Central and Eastern Europe. Cytisine is available in many countries, including Canada and Poland, without prescription. In the UK, you will need a prescription from a doctor or medical professional to get Cytisine.

In the UK, cytisine will be available under the brand name Cytisine. Bonteque Consulting Ltd will hold the licence and distribution will be carried out by Consilient Health.

How does Cytisine work?

Cytisine works similarly to Champix because it copies the effects of nicotine by selectively stimulating the nicotine receptors in the brain so that when you smoke, you receive only a partial reward. Over time, this makes it easier to manage the withdrawal and give up tobacco smoking altogether. By attaching itself to the nicotine receptor, nicotine cannot bind to it.

What’s the difference between Cytisine and varenicline?

Varenicline (Champix) and Cytisine contain different active ingredients. Champix has been considered the most effective smoking cessation aid, but it can cause side effects that can lead to people stopping treatment early.

Cytisine, however, is a plant-based alkaloid that works similarly to varenicline. Walker et al., (2021) found that self-reported side effects over 6 months were reported significantly more frequently in a group taking varenicline compared to cytisine.

How effective is Cytisine?

When it comes to quitting smoking, a study published in the Cochrane Database of Systematic Reviews, found Cytisine to be one of the most effective treatments, alongside e-cigarettes and varenicline.

A study published in The New England Journal of Medicine (NEJM) found that compared to placebo, cytisine was more effective for giving up smoking. A review published in 2013 found that cytisine is a safe and effective smoking aid which is comparable to other licensed smoking treatments. Their review analysed the results from 8 trials involving 4020 adult smokers and reported those using Cytisine to quit smoking had a 59% higher rate of abstinence compared to placebo. The low cost and the benefits of cytisine make it an attractive smoking cessation option.

People who use cytisine to give up smoking were found to be twice as likely to quit compared to a placebo. The same review found that cytisine may be more effective than nicotine replacement therapy.

Cytisine dosage

Cytisine is a tablet. Each tablet contains 1.5 mg of the active ingredient, cytisine.

One pack of Cytisine contains 100 tablets or a complete course of 25 days. Below is a dosage table.

You should stop smoking no later than the fifth day of Cytisine treatments. If you carry on smoking beyond this while taking Cytisine, you may increase the chance of experiencing side effects.

What happens if I take too much Cytisine?

If you take too much Cytisine, it can cause some unwanted side effects. You should seek urgent medical advice if you have taken too many tablets.

What if I miss a Cytisine dose?

If you miss your usual dose of Cytisine, you must not take a double dose to make up for the missed dose. Just skip the missed dose and take your next scheduled tablet as usual.

Who can use Cytisine?

Cytisine is intended for use by people who are serious about giving up smoking. You should avoid nicotine-based products, including cigarettes and nicotine replacement therapy while taking Cytisine because it can lead to adverse effects.

Is Cytisine safe?

Evidence shows that Cytisine is a safe and effective smoking cessation method. It has been used in Europe as a stop-smoking aid by several million people without prescription and no serious side effects have been reported.

A double-blind randomised placebo-controlled trial involving adults who smoked more than 10 cigarettes a day found that any side effects linked to Cytisine use, although common, were not serious.

Cytisine side effects

As with any medication, Cytisine may lead to side effects, though not everyone will experience them. Clinical studies suggest that Cytisine is generally well-tolerated. Most side effects observed are mild to moderate and often involve the gastrointestinal system. It's common for these adverse reactions to appear early in the course of treatment, but they typically resolve as therapy continues. 

Reported side effects can include; 

• increased appetite
• weight gain
•  dizziness
• irritability
• mood fluctuations
• anxiety
• various sleep disturbances (such as insomnia, drowsiness
• lethargy, unusual dreams, or nightmares)
• headaches. 

It's important to note that some of these symptoms might also stem from the process of quitting smoking itself, rather than from Cytisine. Furthermore, Cytisine does not impair your ability to drive or operate machinery. If you encounter any side effects while taking Cytisine, we urge you to report them to the PD prescriber Team. 

As Cytisine is a relatively new treatment, it is crucial to document all side effects through the MHRA Yellow Card Scheme to gather comprehensive safety data.

Cytisine warnings

Before taking Cytisine, you should let our clinicians know if you have:

• ischaemic heart disease
• heart failure
• high blood pressure (hypertension)
• gastric or duodenal ulcers
• gastroesophageal reflux disease
• an overactive thyroid
• diabetes
• schizophrenia
• atherosclerosis
• a tumour in the adrenal glands (pheochromocytoma)

Having one of these conditions doesn’t necessarily mean you can’t use Cytisine to give up smoking. It just means our clinicians will need to assess the risks, and if they think the medication suits you, monitor your body’s response.

Cytisine contraindications

You should not take Cytisine if you:

• are under 18
• are 65 or over
• are allergic to Cytisine
• are allergic to any of the ingredients in Cytisine tablets
• have unstable angina
• have recently had a heart attack
• experience an irregular or abnormal heartbeat (arrhythmias)
• have recently had a stroke
• are pregnant or breastfeeding

If you are taking an oral contraceptive pill, like the combined pill, you should consider using additional contraception methods, such as condoms, while using Cytisine. That’s because not enough is known about the effect of Cytisine on hormonal contraceptives, so additional precautions are recommended.

Interestingly, a report published in 2018 found that women taking hormonal contraception reported more severe withdrawal symptoms when quitting smoking using nicotine replacement therapy. However, compared to women not taking hormonal contraception men, those using hormonal birth control were more likely to have still quit smoking at the end of the nicotine replacement treatment.

You should not use Cytisine with any anti-tuberculosis (TB) medicines. Let our clinician know if you are taking any other medications before using Cytisine, so they can check your suitability.

Cytisine during pregnancy and breastfeeding

Cytisine should not be used by pregnant or breastfeeding women because there is limited evidence relating to its effects.

If you are pregnant, you can use nicotine replacement therapy if you are unable to quit without it. However, it is strongly recommended that you get advice from a healthcare provider before starting any new treatment.

Are there any alternatives to Cytisine?

Yes, at Prescription Doctor we offer other smoking cessation options. They are:

• Champix (our clinicians will look to prescribe Zyban or Cytisine)
• Zyban

Zyban helps you to quit smoking by acting on the neurotransmitters in the brain responsible for nicotine cravings and withdrawal. The active ingredient, bupropion hydrochloride, helps to make these symptoms more manageable.

Where can I buy Cytisine online?

You can purchase Cytisine from Prescription Doctor using our online consultation service. Fill out our short online questionnaire and one of our clinicians will review and approve the treatment if appropriate.

After checkout, you can chat with Customer Service advisers or our medical team via ‘My Account’.

FAQS

Sources

Addiction, (2023). Evaluation of the effectiveness of cytisine for the treatment of smoking cessation: A systematic review and meta-analysis

Addiction, (2021). Cytisine versus varenicline for smoking cessation in New Zealand indigenous Māori: a randomized controlled trial.

Addictive Behaviours, (2018). Use of hormonal contraceptives and smoking cessation: A preliminary report

BMJ, (2013). Efficacy of cytisine in helping smokers quit: systematic review and meta-analysis

International Journal of Environmental Research and Public Health, (2022). Efficacy and Safety of Cytisine in Combination with a Community Pharmacists’ Counselling for Smoking Cessation in Thailand: A Randomized Double-Blinded Placebo-Controlled Trial

JAMA, (2021). Effect of Cytisine vs Varenicline on Smoking Cessation.

The New England Journal of Medicine, 2011. Placebo-Controlled Trial of Cytisine for Smoking Cessation