Cytisine

Indications

  • Smoking Cessation (see Tobacco, [[Tobacco]])
    • Meta-Analysis Examining Efficacy of Nicotine Partial Receptor Agonist in Tobacco Cessation (2012) [MEDLINE]
      • Cytisine increased the chances of quitting, although absolute quit rates were modest
      • Varenicline (at standard dose) increased the chances of successful long-term smoking cessation between 2-3x compared with pharmacologically-unassisted quit attempts
      • More participants quit successfully with varenicline than with bupropion
      • Limited evidence suggests that varenicline may have a role to play in relapse prevention
    • Systematic Review/Meta-Analysis of Cytisine in Tobacco Cessation (2013) [MEDLINE]: cytisine is an effective treatment for smoking cessation with efficacy comparable to that of other currently licensed treatments
    • Australian New Zealand Clinical Trials Group Open Label, Non-Inferiority Trial Comparing Cytisine to Nicotine Replacement (2014) [MEDLINE]: when combined with brief behavioral support, cytisine was superior to nicotine-replacement therapy in helping smokers quit smoking at 1 mo/2 mo/6 mo
      • Cytisine was associated with a higher frequency of self-reported adverse events (predominantly nausea/vomiting and sleep disorders): however, only 5% of the cytisine subjects discontinued the treatment
      • Many of the subjects in this study had previously tried nicotine replacement therapy, and all the participants received vouchers for lower cost nicotine replacement: in the cytisine group, 4% used the nicotine replacement vouchers

Pharmacology

  • Partial Agonist of α4β2 Nicotinic Acetylcholine Receptor: similar to varenicline (se xxxx, [[xxxx]])

Metabolism

  • xxxx

Administration

  • xxxx

Dose Adjustment

  • Hepatic:
  • Renal:

Adverse Effects

Gastrointestinal Adverse Effects

Neurologic Adverse Effects

  • Sleep Disorders

Other Adverse Effects

  • xxx
  • xxx
  • xxx

References

  • Placebo-controlled trial of cytisine for smoking cessation. N Engl J Med 2011;365:1193-1200 [MEDLINE]
  • Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2012;4:CD006103 [MEDLINE]
  • Efficacy of cytisine in helping smokers quit: systematic review and meta-analysis. Thorax 2013;68:1037-1042 [MEDLINE]
  • Cytisine versus nicotine for smoking cessation. N Engl J Med 2014;371:2353-2362 [MEDLINE]
  • Cytisine—a tobacco treatment hiding in plain sight. N Engl J Med 2014;371:2420-2421 [MEDLINE]