Cytisine and other methods to quit smoking according to the expert

Eugene Spagnuolo

November 16th

– Milano

Good news for anyone who wants stop smoking: there is a treatment, natural and with very few side effects, which has been shown to work in 50% of cases. For a total cost that is around 70 euros. Too good to be true? Not at all: the citisina – this is its name – it really exists. And for a few days the study by the IRCCS Foundation of the National Cancer Institute of Milan has been going around the world, which affirms its validity. But how does it work? And who is cytisine suitable for? We asked the doctor Roberto Boffi, head of Pneumology and the Anti-Smoking Center of the National Cancer Instituteone of the authors of the study (which has Dr. Ugo Pastorino, director of Thoracic Surgery of the same Institute as its first signatory, ed) and one of the leading experts in anti-smoking therapies in the world.

Doctor Boffi, let’s start from the beginning: what is cytisine?“It is an alkaloid of vegetable origin, which is extracted from a beautiful yellow flower: the laburnum. A galenic product in capsules is obtained, which is prepared in the pharmacy and must be taken for 40 days. In the study we did at the National Cancer Institute in Milan, we gave it to smokers for free”.

But does it really work better than other smoking cessation treatments?“Following treatment with cytisine, one third of healthy volunteers, chosen among heavy smokers (at least 20 cigarettes a day, 30 years of smoker and 55 years of age) definitively gave up smoking (for more than a year). “other significant share has drastically reduced. But these data are even better in anti-smoking centers like ours, where with the integrated pharmaco-psychological treatment we are reaching percentages close to 50%: 1 out of 2 people stop smoking forever“.

And the side effects? Smoking cessation treatments usually have some.“In reality, cytisine is very well tolerated: it is safe, it gives very few side effects. A bit of nausea – at times – but transient. Since 90% of it is eliminated by the kidneys, in most cases it is sufficient to drink at least 1, 5 liters of water a day to prevent it from accumulating and causing nausea or abdominal bloating”.

Is cytisine addictive?“No, it’s not addictive, even compared to e-cigarettes. Unlike the nicotine in cigarettes, it’s not a drug at all.”

But how exactly does it work?“Cytisine is a nicotine agonist/antagonist: as an agonist somewhat simulates the pleasant effect of nicotine, but without generating addiction. As an antagonist, however, it displaces nicotine by binding to its receptors, so those who take it and smoke begin to no longer feel pleasure from the cigarette but rather disgust, because nicotine does not reach its target in the brain”.

Is there a specific way to take cytisine to quit smoking?“Yes, it should be taken at an increasing dose, daily. The complete treatment lasts 40 days, but you should try to stop by the 14th day, and then start decreasing the number of capsules (from 1.5mg). We prescribe 200 capsules of 1.5 mg which must be prepared in the pharmacy: the cost is around 70/80 eurosan acceptable figure if we consider that we are talking about a complete 40-day treatment and the cost of cigarettes much higher”.

What are the benefits of cytisine over other smoking cessation treatments such as varenicline or bupropion?“Varenicline is a close relative of cytisine. It is a product, currently no longer available on the market, effective but less well tolerated: in fact, it could cause annoying sleep disturbances, with vivid dreams and sometimes nightmares. Cytisine on the other hand is much better tolerated, perhaps because it is natural. Bupropion, on the other hand, is a drug of the antidepressant class, which we still give, but only to certain selected patients. It’s not good for everyone: first of all it’s not a nicotine antagonist, and then it’s a slightly exciting antidepressant, which tends not to give serenity but hyperexcitability. And we prefer not to prescribe it to anyone who is anxious or hyperexcitable. We reserve it for people with low mood or who want to lose weight or who see not gaining weight as a priority (because bupropion is more anorectic than all other anti-smoking drugs)”.

What about nicotine substitutes?“Those who want to quit smoking shouldn’t underestimate the nicotine replacement products such as gum, candy, inhalers, sublingual sprays, patches: they are the quickest to act and the simplest. Even if they shouldn’t be used wrongly, but with criteria. Nicotine therapy helps in 25% of cases: it’s good for certain types of smokers who want something to use as needed. In this he is still unsurpassed.”

Who wants to try cytisine where can you find it?“It is given in anti-smoking centres, even if perhaps not everyone knows it so well. In reality, any doctor can prescribe it. But it is a product that must be carefully explained, not simply prescribed. It has a short half-life, and in key moments it should be taken 6 times a day. This is why it is important to take care of the patient who takes it, even with counseling. In this the anti-smoking centers have something extra. It is no coincidence that the results we have seen in centers like ours in Milan are spectacular: in fact, almost 50% of people stop smoking permanently“.