Cytisine

Cytisine is a stop-smoking medication that’s been available in the EU since the 1970s, but has recently been approved as a prescription medication in the UK. It’s a tablet that is taken several times a day.

The medication is made from several types of plants and seeds, but most commonly from a plant known as Laburnum or golden chain.

Cytisine is both the name of the drug and the active ingredient it contains. It is similar to another stop smoking medication called varenicline (Champix) that’s been available in the UK for much longer.

Cytisine helps people who have the motivation to stop smoking to overcome their cravings and give up smoking. It works by binding to the same receptor in the brain as nicotine. This means there’s no space for nicotine to bind, so it stops nicotine’s activity in the brain.

When binding to the receptor, cytisine also partially activates it. This means it stops the withdrawal symptoms, but does not give the same intense sensation or addictive effects as nicotine.

How long does cytisine take to work?

Cytisine starts working within minutes and reaches its peak concentration around 120 minutes after taking it. The drug is quickly broken down and removed by the body, with 50% gone from the blood after 4 hours. This is why you take the drug very often to start with – every 2 hours initially.

How effective is cytisine?

Studies suggest that people taking cytisine are over 2 times more likely to successfully stop smoking than those taking a placebo (inactive drug). Cytisine was also found to be more effective than nicotine replacement therapy (including nicotine patches, gums, and lozenges) for stopping smoking.

Take one 1.5mg cytisine tablet every 2 hours for the first 3 days, up to a maximum of 6 tablets a day. During this time, you should cut down on how many cigarettes you’re smoking and should stop completely by day 5.

From days 4 to 12, you can take 1 tablet every 2.5 hours, up to a maximum of 5 tablets a day. Then, from days 13 to 16, take 1 tablet every 3 hours, up to a maximum of 4 tablets a day.

For days 17 to 20, you can take 1 tablet every 5 hours up to 3 times a day, and for days 21 to 25, you can take 1 to 2 tablets a day.

How long do you need to take cytisine for?

It may be most effective to continue treatment for 12 weeks, but this will need to be discussed with a healthcare professional.

If you are unable to stop smoking by day 5 or you start smoking again during treatment, stop taking cytisine. You may be able to try taking the medication again in 2 to 3 months.

Many people take cytisine without any issues, but it’s possible to experience side effects while taking this medication.

Very common side effects that can affect more than 1 in 10 people include:

• appetite changes
• weight gain
• dizziness
• irritability, mood changes, and/or anxiety
• sleep disorders
• headaches
• fast heart rate
• rash
• dry mouth
• feeling or being sick (nausea or vomiting)
• diarrhoea
• constipation
• taste changes
• heartburn
• abdominal pain
• fatigue

Common side effects affecting up to 1 in 10 people can include:

• difficulty concentrating
• a slow heart rate
• bloating
• a burning sensation on the tongue
• generally feeling unwell

Uncommonly, between 1 in 100 and 1,000 people may experience:

• decreased sex drive
• heaviness in the head
• increased tear, saliva, or phlegm production, or sweating
• shortness of breath
• decreased skin elasticity
• tiredness
• raised liver enzyme levels in blood tests

How long do cytisine side effects last?

Most reported side effects happen right after starting the medication, and they may be due to the effects of stopping smoking rather than cytisine. These side effects should improve with time as your body gets used to the medication and the effects of not smoking.

What to do if you get cytisine side effects

Mild side effects like nausea, vomiting, or headaches can be managed at home by staying hydrated, eating plain foods, and taking over-the-counter painkillers like paracetamol.

Weaning off nicotine is known to cause mood changes and can rarely trigger suicidal thoughts. If you experience any mood changes, thoughts of harming yourself, or are worried about your mental health, seek support from a healthcare professional immediately.

If you’re worried about side effects, they’re affecting your daily life, or they’re not getting better with time, speak to a doctor.

Cytisine may not be right for everyone – certain conditions or medications can interact with cytisine and make it less effective, or potentially unsafe.

Cytisine should not be taken by people who are allergic to cytisine or any of the inactive ingredients in the medication that are listed in the patient information leaflet.

Cytisine should also not be taken by people who have:

• unstable angina or have recently had a heart attack
• a significant heart arrhythmia (irregular heart rhythm)
• recently had a stroke

Pregnant or breastfeeding women should not take cytisine as it’s unclear whether it can harm the developing embryo. It’s important for women of reproductive age to use an effective form of contraception while taking cytisine.

Cytisine may not be suitable for people with:

• other types of cardiovascular disease (including high blood pressure, heart failure, and peripheral vascular disease)
• pheochromocytoma (a rare tumour of the adrenal gland on top of the kidney)
• stomach or intestinal ulcers
• acid reflux disease
• hyperthyroidism
• diabetes
• schizophrenia and other mental health conditions

If you experience any of these conditions, you should always discuss them with a healthcare professional before starting the medication.

Cytisine should only be taken by people with a serious intention of weaning off nicotine, as smoking (or using other tobacco-containing products) and taking cytisine together can lead to more significant side effects.

Cytisine and other medications

Certain medications can interact with cytisine, affecting how well one or both medications work. Cytisine should not be taken with anti-tuberculosis drugs, and it may make the contraceptive pill less effective, so condoms should be used while taking cytisine.

Although not directly due to cytisine, stopping smoking can speed up how quickly certain drugs are metabolised, so you should discuss it with your doctor if you plan to stop smoking and take any medications, but especially the following:

• theophylline
• tacrine
• clozapine
• ropinirole
• mipramine
• olanzapine
• clomipramine
• fluvoxamine

Cytisine is a prescription-only medication, so it can be prescribed by your GP or on private prescription from an online doctor service like Asda Online Doctor.

Can I buy cytisine online?

Yes, you can request cytisine tablets quickly and discreetly online from Asda Online Doctor by:

1. Completing a short online health assessment for one of our doctors to review.
2. Placing your order request.
3. If approved, your order will be dispatched and sent to your home address in discreet packaging, or you can choose to collect it from your local Asda Pharmacy 4 hours after a doctor’s approval.
4. If your order is not approved, one of our doctors will contact you via your account with alternative treatment options.

Getting cytisine via our service makes it quick and convenient to request your stop smoking medication without the need to visit your doctor.

Can I buy cytisine over the counter?

No, cytisine is not available over the counter in the UK as it’s a prescription-only medication.

Can I buy cytisine on the NHS?

Yes, cytisine is available on the NHS and can be prescribed by a doctor or a stop smoking specialist. You will need to make an appointment with your doctor to find out if it is suitable and available before you can obtain it.

Cytisine is just one stop smoking medication – there are several alternative options.

Zyban

Zyban is a medication that helps to minimise smoking withdrawal symptoms and cravings. It works on the part of your brain associated with addiction and cravings and can be taken for up to 9 weeks.

Varenicline

Varenicline is the active ingredient in what used to be called Champix (this brand has now been discontinued). It works similarly to cytisine by reducing the urge to smoke, but it is taken for between 12 and 24 weeks.

Nicotine replacement therapies

Some people help themselves to stop smoking by switching from cigarettes to other nicotine-containing products like patches, gums, or lozenges. These can be a helpful way to cut down, but are often not suitable to be taken alongside other stop smoking medications.