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Cytisine

What it is

A plant-derived partial agonist at nicotinic receptors — pharmacologically a cousin of varenicline, but far older and far cheaper. It has been used for smoking cessation in Eastern Europe for decades; a modernized form (cytisinicline) is under development.

How it works

Like varenicline, it partially activates nicotinic receptors, easing withdrawal while reducing the reward from smoking. Treatment courses are typically short — about 25 days with a tapering tablet schedule.

What the evidence shows

  • West et al. (NEJM 2011): cytisine significantly increased 12-month abstinence versus placebo (8.4% vs 2.4%) — see R-016.
  • Walker et al. (NEJM 2014): at 1 month, cytisine outperformed NRT (40% vs 31%); by 6 months the difference narrowed (22% vs 15%) and was not statistically significant, at a fraction of NRT's cost — see R-017.
  • Cochrane's partial-agonists review covers cytisine within its scope — see R-002.
  • WHO (2024) recommends cytisine; NICE added cytisinicline recommendations in its 2025 review. Cytisine is not FDA-approved in the US, so USPSTF's US recommendation set does not include it.

Common considerations

  • Dry mouth and gastrointestinal symptoms are commonly reported; side effects are generally mild and self-limiting.
  • Cost is the standout feature: cytisine courses cost a small fraction of varenicline or NRT in most markets, which is why WHO emphasizes it for global access.
  • Availability is the main practical barrier in countries where it is not licensed.

Questions to ask a healthcare professional or pharmacist

  • Is cytisine available and licensed where I live?
  • Does the short course fit my situation, or would a longer treatment be better?
  • How does cytisine compare with varenicline for me?

Related: Varenicline · NRT · WHO 2024 guideline