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In 2021, Varenicline is the most effective single drug for quitting smoking smokingwas withdrawn from the market in UK Because impurities were found at levels higher than what is considered safe.
Rapidly, varenicline (then sold under its brand names, Champix and Chantix) became unavailable. It was a disaster for public health. research from University College London It is estimated that varenicline being unavailable resulted in approximately 1,890 more avoidable deaths each year because fewer people were successfully quitting smoking.
But there was hope. Cytisine (also known as cytisinline), a naturally occurring plant-based product that has been used for decades in Eastern Europe, and has recently had great success elsewhere in the world, was licensed in the UK and made available from January 2024.
Nevertheless, there was an extended period when there was none available to people trying to quit smoking in the UK (and other countries too). But at least in Britain things were looking better.
Based on limited but growing evidence, cytisine probably works as well as varenicline to help people quit smoking, and it may be better tolerated with fewer side effects.
It may also attract more smokers who want to use a natural product instead of a laboratory-designed drug. Therefore, with the withdrawal of varenicline and the availability of equally effective treatments, we should have seen lives saved as people who would have taken varenicline were encouraged to try cytisine instead.
Why isn’t anyone determining this?
It did not happen. Cytisine – despite now being licensed and available in the UK – is still surprisingly underused.
Since January 2024, only 0.2 percent of people trying to quit smoking have used it (the same proportion that used it in 2018, when it wasn’t even officially available in the UK). Officer NHS Data from people accessing stop smoking services in England confirms that only 0.7 per cent were prescribed cytisine in 2024.
So why is it so? High-profile trials have been showing the effectiveness of cytisine for quitting (and even quitting) smoking vaping,
It may be that cytisine’s relatively complex dosage schedule puts people off. Cytisine starts at six tablets a day (one every two hours) and is gradually reduced over a few weeks: more confusing and less convenient than once-a-day varenicline.
About the authors
Jonathan Livingstone-Banks is a lecturer and senior researcher in evidence-based healthcare at the University of Oxford.
Dimitra Kale is Senior Research Fellow in Health Psychology at UCL.
Lion Shahab is Professor in Health Psychology at UCL.
This article is republished from The Conversation under a Creative Commons license. read the original article,
Another possibility is that the public’s attention has shifted. With so much focus on vaping as a smoking cessation aid in recent years, prescription medications for smoking cessation may have fallen off the radar.
It may also be that GPs are reluctant to prescribe cytisine because of its cost and the perception that local authorities should pay for it, not primary care. While it was once hoped that due to its low-cost availability in Eastern Europe, it would become “the Aspirin of smoking cessation drugs”, the product licensed in the UK is now equivalent to or even more expensive than other drugs.
But the simplest explanation is probably the most accurate: Not enough people know about cytisine. For people who smoke, GPs, pharmacists and even stop smoking services may not know that it is an option. And if no one is talking about it, no one is prescribing it. And even if they are aware of it, they may lack confidence in using or prescribing it because it is a new drug.
This is a problem. The UK government has made preventing disease, rather than treating it, a central part of its health strategy. Smoking remains the leading cause of preventable death in the country and the world. If we are serious about prevention, effective smoking cessation support must be at the top of the agenda.
Now, varenicline is available again (without its brand name and reformulated to remove impurities). This is welcome news, but only 1.1 percent of smokers reported using varenicline in the past year. This is only a quarter of the number before its removal.
This raises an important question: should we return to prescribing varenicline by default, or is it time to consider cytisine as first-line treatment? Researchers are continuing to learn more about cytisine, but as the evidence continues to grow in favor of cytisine, perhaps a PR campaign is needed for both those prescribing it and those who smoke it.
None of this is to say that cytisine is a miracle cure, or that it will work for everyone. But this is true for every method of helping people quit smoking. Quitting smoking is hard, and people trying to quit need more options, not less, and those options need to be visible and accessible.