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  • Cytisine

    Cytisine

    If you are looking for an effective nicotine-free treatment to help you quit smoking, you may have heard about cytisine. Although it has only recently been recognized in countries such as the United Kingdom and North America, this plant-derived substance has been used successfully for decades by millions of people in Central and Eastern Europe, making it one of the oldest and most reliable ways to quit smoking. It was recently added to WHO’s list of essenial medicines.

    What Is Cytisine?

    Cytisine is a naturally occurring plant alkaloid, a chemical substance extracted primarily from the seeds of plants in the Cytisus and Laburnum genera (like the Golden Rain acacia, which gets its name from its beautiful yellow flowers). It is usually referred to by its generic names cytisine or cytisinicline.

    Like nicotine, cytisine is a natural insecticide, it kills insects by acting on their nervous system, and it also acts on the human nervous system. Its mechanism of action is similar to that of the prescription medication varenicline (Chantix/Champix). Cytisine works by acting as a partial agonist at the nicotinic acetylcholine receptors in the brain, the same receptors that nicotine targets.

    Its action serves two critical purposes: it reduces nicotine cravings and withdrawal symptoms by partially activating these receptors, and it blunts the rewarding effect of smoking by blocking nicotine from fully binding to nicotinic receptors. Essentially, it “tricks” your brain into feeling like you’ve had some nicotine, making the experience of smoking less satisfying.

    A Long History of Use

    Cytisine is not a new discovery. It was first isolated in 1865, and during World War II, it was smoked by German and Russian soldiers as an accessible, cheap substitute for tobacco. However, its formal use as a pharmaceutical smoking cessation aid began in 1964, when the Bulgarian company Sopharma first marketed it under the brand name Tabex. Since the 1970s, it has been widely available and highly popular across many Central and Eastern European countries. Its extensive and long-term use has provided substantial data on its safety and effectiveness.

    How Effective Is Cytisine?

    The evidence supporting cytisine’s efficacy is strong and growing. Rigorous modern studies and meta-analyses have consistently demonstrated that smokers who use cytisine are about 1.3 times to 1.75 times more likely to achieve long-term abstinence compared to those using a placebo. Even with its short treatment course, cytisine has been found to be as effective as varenicline, and more effective than NRT (nicotine replacement therapy). Also, cytisine leads to a lower number of people reporting serious adverse effects compared to varenicline.

    Given its efficacy and low cost, cytisine is often cited by public health experts as a medicine with the potential to have a major global impact on smoking rates. Cytisine was recently (2025) added to the World Health Organization (WHO) list of essential medicines, which could facilitate its adoption in more countries.

    Side Effects and Withdrawal

    The most commonly reported side effects of cytisine are mild to moderate and tend to occur mainly at the beginning of the treatment course before resolving. These may include gastrointestinal issues such as nausea, vomiting, dry mouth, or constipation, as well as sleep disturbances (insomnia or drowsiness), headache, dizziness, increased appetite, and irritability.

    It is important to remember that many of these symptoms, such as irritability, sleep problems, increased appetite and mood changes, are also classical symptoms of nicotine withdrawal. It is important to distinguish between the two.

    Dosage and Treatment Duration

    Cytisine is typically taken as a 1.5 mg tablet or capsule and is prescribed as a 25-day course of treatment with a gradually reducing dose.

    The treatment schedule is as follows:

    • Days 1–3: One tablet every 2 hours (Maximum 6 tablets per day)
    • Days 4–12: One tablet every 2.5 hours (Maximum 5 tablets per day)
    • Days 13–16: One tablet every 3 hours (Maximum 4 tablets per day)
    • Days 17–20: One tablet every 5 hours (Maximum 3 tablets per day)
    • Days 21–25: One to two tablets per day (Maximum 2 tablets per day)

    You must stop smoking no later than the fifth day of treatment. Although the standard course is 25 days, some clinical evidence suggests that a longer treatment, up to 12 weeks, may be more effective, but this is not the typical licensed duration.

    Contraindications

    Cytisine is generally not recommended and is contraindicated (should not be used) if you have:

    • A known hypersensitivity (allergy) to cytisine or to any of the excipients in the product.
    • Unstable angina, a recent history of heart attack, or clinically significant heart rhythm issues.
    • A history of recent stroke.
    • Are pregnant or breastfeeding.

    It is also generally not recommended for people under 18 or over 65, or those with severe kidney or liver impairment, due to limited clinical data in these groups. Use with caution is advised for individuals with ischemic heart disease, heart failure, high blood pressure, ulcers, and certain other chronic conditions.

    Main Brands

    Cytisine is authorized for smoking cessation in 34 countries, and is included in the WHO’s list of essential medicines. It is manufactured and distributed by relatively small pharmaceutical companies rather than by “big pharma”:

    • It is sold under the brand name Tabex since the 1960s (manufacturer: Sopharma in Bulgaria),
    • and more recently Desmoxan (manufacturer: Aflofarm in Poland), and the same product by Aflofarm is sold under different brand names in different countries:
      – Defumoxan in Romania,
      – Liberisan in Hungary,
      – Tadocitan in Spain,
      – Asmoken in Austria and Germany,
      – Decigatan in Belgium and the Netherlands,
      – Dextazin in Portugal, and
      – generic Cytisine in the UK.
    • Other brands include Cravv in Canada by Zpharm,
    • and Tactizen in the UK.
    • The Polish firm Adamed Pharma produces cytisine tablets under the brand names Recigar (sold in also in Russia and Ukraine), and Cytisinicline Adamed, Glavrinxa and Belnifrem in the UK, distributed by Viatris.
    • In Thailand, the Government Pharmaceutical Organization produces tablets under the brand name Cytisine GPO.
    • In Australia, Quit4Good sells cytisine tablets that dissolve under the tongue, Nicoiq sells oral strips, and QSN sells cytisine tablets under the name NaturQuit.
    • In the USA, the company Achieve Life Sciences conducted several randomized trials with the objective of obtaining FDA approval for its cytisinicline product.
    • In some other countries, cytisine is not available as a commercial product, but is available as a compounded magistral preparation dispensed by pharmacists on medical prescription.
    • There are probably other brands and manufacturers, so please tell us if you know of any, using the “Comments” field below.

    Important: If you are considering using cytisine to quit smoking, it is essential to discuss this with your doctor beforehand to ensure that it is an appropriate and safe choice for you. Only use cytisine if prescribed by a doctor; do not purchase it online without a prescription.

    The Stop2smoke website provides information on other smoking cessation medications, such as varenicline or Nicotine Replacement Therapy (NRT)

    References:

    Read an comprehensive summary on cytisine here.

    Cytisine. By Robert West, Magdalena Cedzyńska and Andy McEwen, with contributions from Julia Robson, Lou Ross. Editor: Andy McEwen. UK National Centre for Smoking Cessation and Training (NCSCT): March 2025 (PDF).

    Etter JF. Cytisine for smoking cessation: a literature review and a meta-analysis. Arch Intern Med. 2006 Aug 14-28;166(15):1553-9. doi: 10.1001/archinte.166.15.1553. PMID: 16908787.

    Etter JF, Lukas RJ, Benowitz NL, West R, Dresler CM. Cytisine for smoking cessation: a research agenda. Drug Alcohol Depend. 2008 Jan 1;92(1-3):3-8. doi: 10.1016/j.drugalcdep.2007.06.017. Epub 2007 Sep 6. PMID: 17825502.

    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 14 December 2025.

    Tutka, P., Vinnikov, D., Courtney, R. J., and Benowitz, N. L. (2019) Cytisine for nicotine addiction treatment: a review of pharmacology, therapeutics and an update of clinical trial evidence for smoking cessation. Addiction, 114: 1951–1969. https://doi.org/10.1111/add.14721.

    Walker N et al. Cytisine versus nicotine for smoking cessation. New England Journal of Medicine. 2014; 371(25): 2353–2362

    Walker N, Bullen C, Barnes J, McRobbie H, Tutka P, Raw M, Etter JF, Siddiqi K, Courtney RJ, Castaldelli-Maia JM, Selby P, Sheridan J, Rigotti NA. Getting cytisine licensed for use world-wide: a call to action. Addiction. 2016 Nov;111(11):1895-1898. https://doi.org/10.1111/add.13464. Epub 2016 Jul 17. PMID: 27426482.

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  • Treatments of tobacco dependence

    Treatments of tobacco dependence

    The firm decision to quit smoking is a necessary first step, but the path to lasting abstinence requires more than willpower alone. Cigarette addiction is a chronic condition, and treating it effectively demands a sophisticated, two-pronged approach that targets both the physical craving and the ingrained behaviors. Thankfully, science has provided a robust arsenal of medications and support strategies.

    Effective Medications:

    The physical aspect of nicotine dependence is addressed through pharmacological treatments that work on the brain’s neurochemistry.

    Nicotine Replacement Therapy (NRT): The most familiar approach, NRT works by delivering clean, controlled doses of nicotine without the thousands of toxic chemicals found in tobacco smoke. This helps to alleviate the acute physical withdrawal symptoms. NRT comes in various forms, including patches (for a steady, all-day supply), gums, lozenges, inhalers, and mouth sprays (for fast relief during intense cravings). Combining a long-acting product, like the patch, with a short-acting product, such as the gum or lozenge, is often the most effective way to manage both basal cravings and breakthrough urges.

    Prescription Medications: Three prescription medications are highly effective.
    – Varenicline, often considered a first-line therapy, works by partially activating the same nicotine receptors in the brain. This dual action reduces both withdrawal symptoms and the satisfaction or “reward” derived from smoking a cigarette, making smoking less appealing.
    – Bupropion, an antidepressant originally, works on different brain chemicals (dopamine and norepinephrine) to help lessen the symptoms of withdrawal.
    – Cytisine, a plant-based alkaloid, is also a highly effective and increasingly utilized alternative that acts similarly to varenicline, and is available in many, but not all, countries.

    Behavioral Support:

    While medication handles the physical dependence, psychological and behavioral support is crucial for addressing the years of habits, routines, and emotional associations linked to smoking. This support provides the tools necessary to navigate life without tobacco.

    Cognitive Behavioral Therapy (CBT): CBT helps patients identify the specific triggers—the morning coffee, a stressful meeting, a social setting—that lead to smoking. A therapist works with the individual to develop tailored coping mechanisms and strategies to break these conditioned responses and prevent relapse.

    Motivational Interviewing (MI): This client-centered counseling style is particularly useful for smokers who are ambivalent or uncertain about quitting. MI avoids confrontation and instead uses a collaborative approach to help the person explore their own reasons for change, building intrinsic motivation and confidence in their ability to succeed.

    The Synergy of Combined Treatment:

    The consensus among health professionals is clear: combining medication with behavioral support offers the highest chance of long-term success. Medication tackles the neurobiological drive, and support addresses the psychological and behavioral patterns. Used together, the two methods provide a protective shield that is significantly stronger than either approach used alone. Studies suggest that this combined therapy can almost double the odds of successfully quitting compared to an unaided attempt.

    Addressing Common Reservations About Medications:

    Despite the clear evidence, many smokers hesitate to use cessation medication, often due to persistent myths.

    Objection: “If I really wanted to quit, I could do it with willpower alone.”

    Response: This objection misunderstands the nature of addiction. Nicotine dependence is a complex, chronic condition involving neurochemical changes, not a failure of character. Medication helps correct the chemical imbalance, leveling the playing field so willpower has a real chance to work. Only a small fraction of unaided attempts are successful in the long term.

    Objection: “The side effects of the medication are more dangerous than smoking.”

    Response: This is unequivocally false. Smoking exposes the body to thousands of toxins and carcinogens, causing cancer, heart disease, and lung disease. The approved cessation medications, while they may have minor side effects (like nausea or vivid dreams), are used for a short, therapeutic duration and are profoundly safer than continuing to smoke.11 Nicotine in NRT, for example, is delivered without the harmful combustion products that cause the vast majority of tobacco-related illness. Nicotine itself does not cause cancer.

    Accessing Support Beyond the Clinic Walls:

    Effective support is increasingly accessible through various channels.

    Helplines and Quitlines: In many regions, specialized telephone helplines offer free, confidential, one-on-one counseling provided by trained cessation specialists. They are a convenient and highly effective form of behavioral support.

    Group Therapy: Quitting in a group setting can provide a sense of community, shared experience, and accountability, significantly boosting motivation and offering invaluable peer support.

    Online Interventions and Apps: Modern technology has introduced apps and online programs that provide structure, tracking, daily tips, and virtual coaching, offering flexible support that can be accessed anytime and anywhere.

    The Role of Novel Nicotine Products:

    The emergence of e-cigarettes (vaping), heated tobacco products (HTPs), and nicotine pouches has introduced a new dynamic to the quitting conversation. These products are generally seen as less harmful than traditional combustible cigarettes because they eliminate combustion and thus reduce exposure to most toxins.

    E-cigarettes (Vaping): Some regulatory bodies now recommend e-cigarettes as a tool for smoking cessation. The evidence shows that, when used as a complete replacement for cigarettes, nicotine-containing e-cigarettes are more effective than NRT in helping smokers quit. However, health professionals caution that the goal must be complete nicotine cessation, not dual use (smoking and vaping), and the long-term health effects of vaping remain under study.

    Heated Tobacco and Nicotine Pouches: These products are part of the “harm reduction” spectrum. HTPs heat tobacco instead of burning it, and nicotine pouches contain no tobacco leaf, only nicotine and flavorings. While they reduce exposure to some toxicants compared to smoking, they are still addictive nicotine delivery systems. Their role in smoking cessation is debated, but they are often viewed by experts as a less desirable path than using approved medication, which has a clear track record and a defined endpoint for use.

    The most successful treatment is one that is chosen in consultation with a healthcare provider and tailored to the individual’s level of dependence and personal circumstances and preferences, combining medications with behavioral strategies.

    Use the ‘Comments’ field below to share your experience or to suggest improvements to this page.