Cytisine could save lives, yet almost no UK smokers are being offered the proven stop smoking drug

A proven quit-smoking drug that could save thousands of lives each year is being all but ignored in the UK — even after becoming officially licensed.

Cytisine, a plant-based medication used in Eastern Europe for decades, was finally approved for use in the UK in January 2024. Yet NHS data shows that just 0.2% of smokers trying to quit have used it this year — exactly the same proportion as in 2018, when it wasn’t even legally available. Among those accessing England’s stop-smoking services, the figure is barely higher at 0.7%.

The low uptake is baffling, given that large clinical trials have repeatedly shown cytisine to be an effective tool for quitting smoking — and even for stopping vaping. But despite the evidence, the drug remains a virtual unknown among smokers and, it seems, many GPs.

So why isn’t cytisine being prescribed?

One reason may be its dosing schedule. Unlike varenicline — another prescription-only quit aid — which is taken once a day, cytisine requires six pills daily to start, gradually tapering off over several weeks. For some, this complexity may be off-putting.

Another factor could be cost. Although it was once touted as a cheap alternative — the so-called “aspirin of smoking cessation” — the UK-licensed product is now as expensive, or more expensive, than other prescription options. That may make some GPs reluctant to prescribe it, especially if they believe local public health budgets, not primary care, should bear the cost.

Attention may also have shifted in recent years toward vaping as a smoking cessation tool. With so much media and political focus on e-cigarettes, traditional prescription drugs for quitting smoking have slipped out of the spotlight.

But perhaps the simplest explanation is awareness — or rather, the lack of it. Many smokers have never heard of cytisine. Some GPs, pharmacists, and even specialist stop-smoking advisers may not know it exists, let alone how to prescribe it. And without knowledge or confidence in the treatment, uptake remains stubbornly low.

This lack of awareness stands in sharp contrast to the government’s stated public health goals. Ministers have made prevention — rather than treatment — the central plank of their health strategy. Smoking remains the leading cause of preventable death in the UK and globally, claiming tens of thousands of lives each year.

Meanwhile, varenicline, withdrawn from the market in 2021 due to impurities, has now returned in a reformulated version. That’s good news, but uptake has also plummeted. Only 1.1% of past-year smokers reported using it in 2024 — less than a quarter of the numbers seen before its withdrawal.

The question now is whether healthcare providers should automatically revert to prescribing varenicline, or whether it’s time to make cytisine a first-line choice. Researchers are still learning more about cytisine, but the mounting evidence in its favour is hard to ignore. Some experts believe what’s needed now is not another trial, but a publicity push — for prescribers, pharmacists, and smokers alike.

Cytisine is not a miracle cure. Like every quit aid, it works for some people and not for others. Quitting smoking is notoriously difficult, and the more tools available, the better the chances of success. The real problem is that one of the most promising tools remains hidden in plain sight.