by Dr Deborah Lee, Dr Fox Online Pharmacy
https://pixabay.com/photos/cigarette-reaper-smoke-embers-ash-2456476/
Image by Sarah Richter from Pixabay
Great news! On the 22nd of January 2024, a new medicine called cytisine became available in the UK to help people trying to stop smoking. Cytisine is available under the brand names Tabex, Desmoxan and Cytisinicline.
Smoking is nicotine addiction
Giving up smoking is one of the hardest things to do. Research shows that on average, smokers attempt to give up 30 times before they succeed. The problem is that nicotine in tobacco is highly addictive. Smoking is a nicotine addiction. Withdrawing from nicotine is as hard as withdrawing from drugs such as heroin or cocaine. There is an urgent need to find ways to help smokers to quit.
In the UK 96,000 people die every year as a direct result of smoking. On average, a smoker will lose 10 years of life. In addition, smokers start to develop chronic diseases about 10 years earlier than nonsmokers, which severely lowers their quality of life.
Stopping smoking is the single best thing you can do to improve your health.
Nicotine withdrawal symptoms
Nicotine withdrawal symptoms are very unpleasant. They include nausea, headache, dizziness, postnasal drip, cough, chest tightness, insomnia, diarrhoea or constipation. Nicotine withdrawal also causes mental health symptoms which include feeling jittery, anxious, irritable, angry, fatigued, sad and depressed. Cytisine can help control many of these symptoms.
What is cytisine?
Cytisine is present in the seeds of a tree known as Laburnum anagyroides, also called (the Golden Rain tree. The molecule attaches to alpha 4- beta 2, nicotine receptors in the brain. It also partially stimulates cerebral nicotinic acetylcholine receptors, causing the release of dopamine, the hormone that drives the pleasure/reward centres, helping a person feel less stressed and more relaxed.
What’s the evidence for the effectiveness of cytisine?
In a 2023 review and meta-analysis in the journal Addiction, the authors reviewed 12 randomised controlled trials of over 6000 smokers, of which eight trials compared cytisine with the use of a placebo.
Taking cytisine more than doubled the chance of giving up smoking in comparison to taking a placebo. In 3 trials, it was found to be more helpful in quitting than other forms of nicotine replacement therapy (NRT). However, in 2 studies, it was not found to be superior to varenicline, but this has currently been withdrawn in the UK due to safety fears.
Cytisine was found to be safe, with a low risk of adverse events and most of these were minor gastrointestinal symptoms such as dry mouth, nausea, change in appetite, and a small rise in blood pressure.
Who is eligible for cytisine?
Anyone who wants to quit smoking is eligible to try cytisine. However, it is a prescription -only medicine and must be prescribed by your GP or local stop-smoking service.
Cytisine – the formulation and how to take it
Cytisine is a tablet or a capsule. It is initially prescribed for 25 days but can be used for up to 12 weeks. Cystine as Tabex, should be taken 6 tablets a day to start with, gradually reducing the number of tablets to 2 a day by the end of 25 days.
Who is not suitable for cytisine?
Cytisine is not currently recommended for those under the age of 18, women who are pregnant or breastfeeding, anyone aged 65 or over, or those with kidney failure or liver failure. It’s also not recommended for anyone with unstable angina, who has had a recent heart attack or a stroke or has a heart arrhythmia.
For women using hormonal contraception, a barrier method such as a condom should also be used when taking cytisine, as any drug interactions are not known. It also should be used by anyone taking anti-TB drugs.
Cytisine should be used with caution in those with known ischaemic heart disease, diabetes, high blood pressure, heart failure, stomach or duodenal ulcers, gastric reflux and schizophrenia.
Final thoughts
It’s never too late to stop smoking. The benefits of not smoking start to accrue from one hour after your last cigarette. Perhaps cytisine could give you the support you need to succeed.
- Do you need help stopping smoking?
- Why not contact your local NHS Stop Smoking service right away? Click here to find your nearest service. You are four times more likely to quit if you get support than if you go it alone.
For more information
- National Centre for Smoking Cessation and Training (NCSCT) – Cytisine