Increased Risk of Lung Disease in the Setting of Alpha-1 Antitrypsin Deficiency (see Alpha-1 Antitrypsin Deficiency, [[Alpha-1 Antitrypsin Deficiency]])
Lung Cancer (see Lung Cancer, [[Lung Cancer]]): increases risk
Renal Adverse Effects
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Gastroenterologic Adverse Effects
Colorectal Cancer (see Colorectal Cancer, [[Colorectal Cancer]]): increases risk
Treatment of Tobacco Addiction
Bupropion (Wellbutrin, Zyban) (see Bupropion, [[Bupropion]])
Pharmacology: non-SSRI and non-TCA norepinephrine-dopamine reuptake inhibitor
Pharmacology: partial agonist of α4β2 nicotinic acetylcholine receptor (similar to varenicline)
Clinical Efficacy
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
References
Placebo-controlled trial of cytisine for smoking cessation. N Engl J Med 2011;365:1193-1200 [MEDLINE]
Risk of serious adverse cardiovascular events associated with varenicline: a systematic review and meta-analysis. CMAJ 2011;183(12): 1359-1366 [MEDLINE]
Risk of cardiovascular serious adverse events associated with varenicline use for tobacco cessation: systematic review and meta-analysis. BMJ 2012; 344:e2856 [MEDLINE]
A randomized placebo-controlled trial of varenicline for smoking cessation allowing flexible quit dates. Nicotine Tob Res 2012;14:343-350 [MEDLINE]