Cytisine, the world’s oldest smoking cessation aidBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5198 (Published 23 August 2013) Cite this as: BMJ 2013;347:f5198
- Judith J Prochaska, associate professor of medicine1,
- Smita Das, resident physician2,
- Neal L Benowitz, professor of medicine and bioengineering and therapeutic sciences3
- 1Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA 94305-5411, USA
- 2Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- 3Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, CA, USA
Nearly 50 years ago, and before any smoking cessation aids were approved in the Western world, cytisine was being used in eastern and central Europe to help people quit smoking. An alkaloid with high affinity for the α4β2 nicotinic acetylcholine receptor subtype, cytisine is derived from the plant Cytisus laburnum. It was discovered in 1818, first isolated in 1865,1 and its actions were documented as “qualitatively indistinguishable from that of nicotine” in 1912.2 It was smoked as an accessible and cheap tobacco substitute by German and Russian soldiers during the second world war, and it was brought to market in 1964 as a cessation aid under the brand name Tabex, now produced by Sopharma, a Bulgarian drug company. Currently, the recommended course of treatment starts at one tablet every two hours (six in total per day) for one to three days, tapered gradually, with a scheduled quit date at day 5, and ending with one to two tablets daily by days 21-25. Optimal doses and duration of treatment, however, are as yet undetermined because no human pharmacokinetic data have been published.