Cytisine (Tabex) is the cheapest evidence-based cessation medication in the world, and one of the most under-used outside Eastern Europe. Same mechanism as varenicline, a fraction of the cost.
How it works
Cytisine is a partial agonist at the α4β2 nicotinic acetylcholine receptor. It occupies the receptor enough to blunt withdrawal, while blocking nicotine from binding fully — same double action as varenicline.
Standard dosing (25-day schedule)
The historical Tabex regimen:
- Days 1-3: 1 tablet every 2 hours (up to 6/day)
- Days 4-12: reduce to 5 tablets/day
- Days 13-16: 4/day
- Days 17-20: 3/day
- Days 21-25: 1-2/day
Quit day is around day 5. Newer trials use longer courses (up to 12 weeks) with similar safety.
Effect size
The 2024 head-to-head trial (Courtney et al.) found cytisine non-inferior to varenicline. Cochrane rates it more effective than placebo and roughly comparable to NRT.
Side effects
- GI upset (nausea, dry mouth): usually mild.
- Mild insomnia: first week only.
- Mild headache.
Overall side-effect profile is milder than varenicline in most head-to-head data.
Availability
- OTC: Bulgaria, Poland, Russia, several Eastern European markets.
- Prescription: UK (as of 2024).
- Under FDA review: cytisinicline (a newer formulation), not yet approved in the US.
- Grey market: US users sometimes import from EU; not medically supervised, and not endorsed here.
Who it suits
- Cost-constrained quitters where cytisine is available
- Quitters who want the varenicline mechanism with fewer side effects
- Anyone in a market where cytisine is OTC or on formulary
The bottom line
Cytisine is the most under-recognised cessation medication in the world. Where it is available, it is a strong first-line option. See our comparison table for how it stacks against varenicline and bupropion.
