Stop smoking

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

Get help from Dr Fox to stop smoking.

• Safe and effective prescription-only medication for smokers aged 18 years or over.
• Reduces nicotine cravings during stop smoking attempts.

Treatments available

• Varenicline (generic Champix)
• Cytisine

Only one type of stop smoking medication should be used at a time. They should not be used together.

Branded Champix is still unavailable as the manufacturers have not restarted production - how is generic varenicline different to branded Champix?

Quit rate doubled with smoking cessation mediation

Clinical studies have shown that taking varenicline or cytisine can more than double the rate of success in stopping smoking compared with dummy (placebo) tablets.

How varenicline and cytisine work

Varenicline and cytisine work by attaching to the same receptors in the brain as nicotine to block its effects. This causes less cravings for cigarettes and allows a gradual reduction in nicotine dependence and increases the likelihood you will stop smoking.

Varenicline (generic Champix)

How to use

Varenicline tablets are taken twice-daily, usually for 12 or 24 weeks.

The dose is built up over a week, starting 1-2 weeks before target stop smoking date. Please note you will need to purchase a pack of varenicline 0.5mg tablets to start the dosing regime correctly as 1mg tablets can not be broken into two.

The dose can be reduced to 0.5mg twice a day if the higher dose is not tolerated.

An alternative version of the treatment schedule which you may find easier to follow (from the National Centre for Smoking Cessation and Training).

The complete course is for 12 weeks. It can be repeated for a further 12 weeks if there are still significant withdrawal symptoms, or you have reduced but are unable to completely stop smoking in the first 12 weeks.

Varenicline cautions

Dr Fox cannot supply varenicline if you have a diagnosis of the following conditions:

• An allergy to varenicline or any other non-active ingredients in the tablets.
• A psychiatric illness.
• Active depression.
• Seizures, or a condition that makes you more likely to have a seizure.
• Renal failure/severe kidney disease - you will likely need a reduced dose and monitoring by your usual GP.
• Are pregnant or breastfeeding.

When the course of treatment comes to an end, some people experience poor sleep and low mood/depression for a few days. This chance could be reduced by lowering the dose gradually before stopping treatment. To do this, once the course has been completed, reduce to 0.5mg twice a day for a week then 0.5mg once a day for a week.

It is rare but possible to feel suicidal after stopping varenicline - if this occurs you must seek medical advice immediately.

Varenicline may also cause you to have a lower tolerance to alcohol.

Driving and skilled tasks

When starting this medication you should ensure you do not experience dizziness or sleepiness before driving.

Varenicline possible side effects

Varenicline is usually well tolerated, however the most common side effects include headache, nausea, nose or throat inflammation, difficulty sleeping, and abnormal dreams.

For a full list of possible side effects please see the varenicline patient information leaflet.

Cytisine

How to use

Each tablet contains 1.5mg of cytisine and the course is for 25 days. Tablets are taken increasingly less frequently over the course of the 25 days.

Your quit smoking date should be no later than day 5. Continued smoking may worsen any treatment reaction.

An alternative version of the treatment schedule which you may find easier to follow (from the National Centre for Smoking Cessation and Training).

Each day, following your 1st dose of cytisine, we suggest you set a reminder/alarm for the next dose. If you miss a dose of cytisine you should not take a double dose to make up for it, just take the next dose as indicated.

Cytisine cautions

Cytisine should not be used, and Dr Fox cannot therefore supply cytisine, if you have any of the following conditions:

• Hypersensitivity to cytisine or any of the non-active ingredients (mannitol, microcrystalline cellulose, magnesium stearate, glycerol dibehenate, and hypromellose).
• Unstable angina - chest pain due to reduced blood supply to the heart that occurs at rest and minimal exercise. Your GP or cardiologist should be able to advise if you are unsure.
• Had a heart attack within the last 6 weeks.
• A clinically significant abnormal heart rhythm. Your GP or cardiologist should be able to advise you if you are unsure.
• Had a stroke within the last 6 months.
• Are taking anti-tuberculosis drugs.
• Are pregnant or breastfeeding.

Cytisine possible side effects

Cytisine is usually well tolerated, however you may experience the following side effects: change in appetite, weight gain, headache, increased heart rate, increased blood pressure, dizziness, irritability/mood changes, sleep disorders, nausea, vomiting, heartburn, change in taste, constipation, abdominal pain, muscles aches, rash.

For a full list of side effects please read the manufacturer's cytisine patient information leaflet.

Improving your chances of quitting smoking

If you are mindful, notice your cravings, and find strategies to manage them that work for you, you are more likely to succeed in your quit smoking attempt. Here are some hints and tips for you to consider.

Stop smoking support services

As with all medication taken to help stop smoking, varenicline and cytisine work best if there is other support at the same time.

GP surgeries, pharmacies, and local councils may provide access to a variety of stop smoking support services. There is also the following:

• NCSCT - Varenicline: effectiveness and safety
• NHS England — the free Smokefree National Helpline on 0300 1231044 or online NHS stop smoking services help you quit
• NHS England's Smoke Free National Helpline on 0300 1231044 or online NHS stop smoking services help you quit
• NHS Better Health - Quit smoking offers support via a smartphone app, email programme, TXT messages, and a Facebook page
• NHS Scotland - the free Smokeline on 0800 848484, or online NHS inform - Stopping smoking.
• NHS Wales — the free Help Me Quit Wales Helpline on 0800 0852219, or online Help Me Quit
• NHS Northern Ireland: Public Health Agency — Stop smoking
• ASH (Action on Smoking and Health)
• QUIT is a national charity which provides telephone support

Dr Fox supplies varenicline and cytisine tablets on prescription. You are required to complete a medical assessment by answering a short questionnaire to order treatment.

Authored 18 June 2010 by Dr Tony Steele
MB ChB Sheffield University 1983. Former hospital doctor and GP. GMC no. 2825328

Reviewed by Dr J. Tweedie, Dr C. Pugh, Dr B. Babor
Last reviewed 09 October 2024
Last updated 28 November 2024
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