Stop smoking

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

About Cytisine

• Cytisine is safe and effective prescription-only medication.
• Increases stop smoking success by approximately 75% compared with placebo (dummy tablets).
• The standard course of treatment is 25 days but using cytisine for up to 12 weeks is probably more effective.
• Evidence suggests that 25 days of cytisine treatment is as effective as nicotine replacement therapy, however cytisine also weans you off nicotine.
• Cytosine has no known serious side effects.

How cytisine works

Cytisine works by attaching to some of the same receptors in the brain as nicotine, reducing the pleasurable feelings experienced when using nicotine-containing products. Cytisine allows a gradual reduction in nicotine dependence and increases the likelihood you will stop smoking by approximately 75% compared with placebo (dummy tablets).

Cytisine - instructions for use

• Each tablet contains 1.5mg of cytisine.
• One pack of cytisine contains 100 tablets - a complete course of treatment (25 days).
• Each day, following your 1st dose of cytisine, we suggest you set a reminder/alarm for the next dose.
• Note - your quit smoking date should be no later than day 5. Continued smoking may worsen any treatment reaction.
• If you miss a dose of cytisine you should not take a double dose to make up for it. You should just take the next dose as indicated.

An alternative version of the treatment schedule which you may find easier to follow (from the National Centre for Smoking Cessation and Training).

Alternative stop smoking treatments

In the UK several treatments to help you to quit smoking are available in addition to cytisine, including nicotine replacement therapy (NRT), nicotine 'vapes' (electronic cigarettes), bupropion tablets (Zyban), varenicline tablets (Champix), hypnotherapy, psychotherapy, acupuncture, or even reading quit smoking books.

For more information see the NHS - Stop smoking treatments.

Cytisine warnings

Cytisine should not be used if you have:

• Hypersensitivity to cytisine or any of the non-active ingredients (mannitol, microcrystalline cellulose, magnesium stearate, glycerol dibehenate and hypromellose).
• Unstable angina (chest pain due to reduced blood supply to the heart that occurs at rest and minimal exercise. Your GP or cardiologist should be able to advise if you are unsure).
• Had a heart attack within the last 6 weeks.
• A clinically significant abnormal heart rhythm. Your GP or cardiologist should be able to advise you if you are unsure.
• Had a stroke within the last 6 months.
• Are taking anti-tuberculosis drugs.
• Are pregnant or breastfeeding.

Dr Fox cannot supply cytisine if you have any of the above conditions.

Cautions

A caution does not mean that cytisine should not be used. It means that the potential risks of use should be clinically assessed and you should be monitored for possible worsening of an existing medical condition.

Cytisine should be taken with caution if you have:

• Angina (ischemic heart disease) where your heart doesn't receive enough oxygen.
• Heart failure.
• Untreated high blood pressure.
• Pheochromocytoma (a tumour in the adrenal glands).
• A diagnosis of atherosclerosis (a build-up of fatty deposits in arteries which restricts blood flow).
• Peripheral vascular disease (blood flow is restricted to areas other than the heart and brain).
• Gastric or duodenal ulcer (stomach or small intestine ulcer).
• Acid reflux disease.
• Hyperthyroidism (overactive thyroid).
• Diabetes.
• Schizophrenia.

Cytisine - interaction with other medicines

Cytisine should not be used with anti-tuberculosis drugs.

If you take theophylline (to treat asthma), clozapine (to treat schizophrenia) or ropinirole (to treat Parkinson's disease) it is particularly important you speak to your GP before taking cytisine, as your medication dose/monitoring schedule may need changing.

Dr Fox cannot supply cytisine if you take any of the above medications.

If you take tablet-form hormonal contraception, you should also use a secondary barrier method (e.g. condom) while taking cytisine. This is because the impact of cytisine on the effectiveness of oral contraceptives is unknown.

If you use products containing nicotine, or continue to smoke while taking cytisine (beyond the first 5 days), you are more likely to experience adverse reactions.

Cytisine - possible side effects

Clinical studies and experience indicate that cytisine is well tolerated, however you may experience the following side effects:

• Very common (may affect more than 1 in 10): change in appetite, weight gain, dizziness, irritability, mood changes, anxiety, high blood pressure, dry mouth, diarrhoea, rash, fatigue, sleep disorders, headaches, fast heart rate, nausea, change in taste, heartburn, constipation, vomiting, abdominal pain, muscle pain.
• Common (may affect upto 10 in 100): difficulty concentrating, slow heart rate, abdominal distension, burning tongue, malaise.
• Uncommon (affects upto 10 in 1,000): a feeling of heaviness in the head, decreased sex drive, excessive tears, shortness of breath, increased phlegm, excessive spit production, sweating, decreased skin elasticity, tiredness.

For a full list of side effects please read the manufacturer's cytisine patient information leaflet.

Improving your chances of quitting smoking

If you are mindful, notice your cravings, and find strategies to manage them that work for you, you are more likely to succeed in your quit smoking attempt. Here are some hints and tips for you to consider:

• Make a quit plan - think ahead about ways you will manage your cravings if and when they happen. Choose a quit date, stick to it, and seek support from family, friends, and colleagues.
• Know your triggers - cravings and thoughts about smoking can be triggered by the people you spend time with, the places you go, and the situations you encounter. Avoid your triggers, at least temporarily, after you quit to help lessen your cravings and give you time to build confidence and skills for remaining smoke free.
• Distract yourself - practice mindfulness and remember your reasons for quitting. Quitting smoking is great for your health, the health of those around you, and your bank account! Calculate how much money you will save per week / per year and what you could spend your money on instead.
• Get TXT message support - TXT the word CRAVE to 47848 to get 24/7 immediate support whenever you have a craving, or TXT QUIT to 47848 to sign up for SmokefreeTXT, a 6-8 week program of daily TXT message support, tips, and encouragement.
• Use the free Smokefree.gov app – track your cravings and understand your smoking patterns with one of the Smokefree.gov apps.

If you don't manage to quit 1st time, or if you relapse, then try again having learned from your previous experience. To read more see Managing Nicotine Withdrawal.

Dr Fox supplies cytisine 1.5mg tablets on prescription - you are required to answer a short medical questionnaire before your order can be completed.

Authored 18 June 2010 by Dr Tony Steele
MB ChB Sheffield University 1983. Former hospital doctor and GP. GMC no. 2825328

Reviewed by Dr J. Tweedie, Dr C. Pugh, Dr B. Babor
Last reviewed 07 May 2024
Last updated 8 May 2024
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