Comparing Cytisine, Varenicline (Chantix), and Nicotine Replacement Therapies: Effectiveness, Safety, and Side Effects

When it comes to quitting smoking, people often turn to medications or nicotine replacement therapies (NRT) to help manage cravings and withdrawal. Two popular medications are cytisine and varenicline (known as Chantix in the U.S.). Both help reduce cravings by partially blocking the nicotine receptors in the brain, similar to how nicotine works. However, there are important differences in how effective they are, the side effects they cause, and how they compare to NRT products like patches, gums, sprays, and lozenges.

How Do Cytisine and Varenicline Work?

• Cytisine: This is a natural substance found in plants. It binds to the same brain receptors that nicotine does, reducing withdrawal symptoms and cravings when people stop smoking. It also blocks the "reward" people get from smoking if they relapse.

• Varenicline (Chantix): This is a lab-made drug that targets the same brain receptors. It works in a similar way to cytisine by lowering cravings and making smoking less enjoyable. It’s stronger and was designed specifically to help people quit smoking.

How Effective Are They?

Both cytisine and varenicline are effective for quitting smoking, but varenicline works a little better. Studies show:

• Cytisine helps about 22-27% of people quit after six months.
• Varenicline has a quit rate of 30-35% over the same period.

In comparison, NRT products, like patches and gum, are slightly less effective when used alone, with quit rates around 15-20% after six months. However, combining NRT products (such as using both a patch and gum) can boost success rates to levels similar to cytisine and varenicline.

Side Effects

The side effects of these medications vary in severity:

• Cytisine: Common side effects include nausea, vomiting, dry mouth, headaches, and trouble sleeping. However, it is generally considered safer with fewer serious side effects compared to varenicline.

• Varenicline: This medication can cause more serious side effects in some people, such as vivid dreams, sleep problems, nausea (affecting about 30% of users), and mood changes. In rare cases, it has been linked to depression or suicidal thoughts, especially in people with a history of mental health issues. There have also been concerns about heart-related side effects in people with heart conditions, though the evidence is still mixed.

• NRT Products (Patches, Gum, Sprays, Lozenges): NRTs are generally very safe and have mild side effects like skin irritation from patches, or mouth irritation from gum or lozenges. However, they deliver nicotine, which can slightly raise your heart rate or cause dizziness.

Safety and Risk

Cytisine is considered safer than varenicline because it has fewer severe side effects, especially when it comes to psychiatric and heart-related issues. Varenicline, while more effective, carries a higher risk of these problems. NRT products are the safest option overall, but they are less effective when used alone compared to these medications.

Cost and Availability

• Cytisine: This is a more affordable option and widely available in Eastern Europe, but it’s not yet approved in places like the U.S., though it may become available soon.

• Varenicline (Chantix): It’s available globally but tends to be more expensive, especially without insurance. In 2021, varenicline was temporarily withdrawn in some markets due to concerns about impurities but is being reintroduced.

Conclusion

For quitting smoking, both cytisine and varenicline are more effective than NRT products like patches or gum, but varenicline has higher risks, especially for people with mental health or heart conditions. Cytisine, while slightly less effective, has fewer severe side effects and is a good alternative, especially where cost is a concern. NRT products remain a safe and reliable option, particularly when combined, but they are less effective overall. Choosing the right method depends on individual health, preferences, and tolerance for side effects, and it’s always a good idea to consult a healthcare provider.