Varenicline is a non-nicotine drug for smoking cessation. It is an agonist of the nicotine acetylcholine receptor, and has been found useful in its effect in promoting smoking cessation. Some studies have shown that varenicline is more beneficial than nicotine replacement therapy for smoking cessation. Varenicline has been shown to increase chances of successful smoking cessation for up to 12 months by 50% compared with non pharmaceutical interventions. Furthermore, it has been shown to be more effective than Bupropion which was the first non-nicotinic drug for smoking cessation.
However, it should be noted that for successful smoking cessation pharmaceutical intervention is often co-prescribed with other therapies such as Hypnotherapy, Cognitive behaviour therapy (CBT), exercise therapy etc. This is a good example of applying ‘Integrative healthcare solutions’ to improve efficacy.
An important consideration is that nicotine replacement therapy and non-nicotine based drugs do not work for everyone, so is there a better alternative? Some research studies have suggested that Cytisine may be more effective than nicotine agonist and is a low-cost treatment that may be effective in aiding smoking cessation.
Confined strictly in Europe, a plant alkaloid called cytisine discovered several decades ago is used for smoking cessation. Cytisine is a partial agonist of alpha4beta2 nicotinic acetylcholine receptors.
As far back as the 1960’s, cytisine was introduced to assist individuals to quit smoking. However at that time, no evidence was provided showing its beneficial effects. Nevertheless, advancements in studies and efficacy studies have revealed its impact on smoking cessation.
A 2011 efficacy study by West et al highlighted the usefulness of cytisine. Individuals participating in this study were divided into either the cytisine receiving group or the placebo group. Results showed the abstinence rate for the cytisine group was 8.4% and 2.4% in the placebo group. Typically, treatment involving cytisine requires consumption of 1.5mg tablets for 25 days. The quantity of tablet consumed varies over this period. Initially, 6 tablets are taken for the first three days, then 2 tablets for the remaining 22 days. Moreover, cytisine is an affordable treatment, costing approximately $10 per treatment.
The Health Research Council of New Zealand funded the trial conducted from 2011-2014 involving 1310 long-term smokers in New Zealand. The researchers tested the effectiveness of both nicotine replacement and cytisine therapies over a period of 6 months. Participants were divided into two groups where they either received nicotine replacement or cytisine. After a period of one month, results showed 40% of the participants in the cytisine group to be smoke free, whereas only 31% were smoke free in the nicotine replacement group. Despite relapses present in both groups, continuous withdrawal was shown more in the cytisine group rather than the nicotine replacement group. Although cytisine was shown to be a better treatment than nicotine replacement, it did have more adverse effects than the nicotine replacement group.
In conclusion, cytisine has demonstrated its effectiveness over short periods (6-months) and is a much cheaper treatment option, but the long-term effects of cytisine are unknown and its adverse affects i.e. nausea, sleep disorders and vomiting must be considered.
So for now, Varenicline products like Champix and other brands are the conventional pharmaceutical treatment options, but integrative healthcare solutions using hypnotherapy, behaviour modification therapy, energy medicine, yoga and other lifestyle modification advices may be a much wiser approach that not only address the side-effects of pharmaceutical intervention but more pertinently address the deeper issues of nicotine dependency.
