Cytisine from the pharmacy or a course with a doctor? When a consultation matters

Most cytisine products, including Desmoxan, Tabex and Recigar, can be bought at a pharmacy without a prescription, and one pack of 100 tablets is enough for the whole 25-day course. Not everyone can start such a course on their own, however. In some conditions cytisine is not used, and in others caution is needed. After quitting smoking, the blood levels of some medicines you take long term may also rise, because tobacco smoke no longer enters the body. People who have these conditions or take these medicines must discuss the course with a doctor first. Support from a doctor or therapist also increases the chance of quitting smoking, as Cochrane reviews have shown.

In brief

• Cytisine is not used after a recent heart attack or stroke, in unstable angina or significant heart rhythm disorders, during pregnancy or while breastfeeding.
• Coronary heart disease, heart failure, high blood pressure, diabetes, peptic ulcer disease, an overactive thyroid, schizophrenia and other mental illnesses call for caution, so discuss the course with a doctor first.
• After quitting smoking, the levels of theophylline, clozapine, olanzapine and ropinirole, among others, may rise. The reason is that tobacco smoke no longer enters the body, so this also applies to people who use nicotine patches to quit or who quit without any medication.
• Cochrane reviews found that after at least six months, the proportion of non-smokers was higher among people who took medication and had several sessions with a specialist than among those who received usual care or brief advice.

Who can start a course of over-the-counter cytisine without seeing a doctor?

An adult aged 18 to 65 can start a course of over-the-counter cytisine on their own if they have none of the conditions that rule out the medicine or require caution, do not take medicines whose levels change after quitting smoking, are not pregnant or breastfeeding, and are ready to stop smoking by day 5 of the course at the latest.

Women of childbearing age should use effective contraception during the course, and those using hormonal contraception should also use a condom, because it is not known whether cytisine reduces its effectiveness. The tablets are taken according to a fixed dosing schedule, from 6 tablets a day in the first three days to 1 or 2 tablets in the last five days of the course. Smoking or using an e-cigarette, nicotine pouches or nicotine patches during the course may increase the side effects of nicotine. If the course does not work, it should be stopped, and another one can be started after 2 to 3 months (1).

We describe how the course goes day by day in our article on the 25-day course of cytisine. When buying cytisine without a prescription, you can also ask the pharmacist whether the blood level of any medicine you take changes after quitting smoking.

Which conditions require a doctor's consultation before starting cytisine?

Before the course, you need to consult a doctor if you have any heart or blood vessel disease, high blood pressure, a past stroke, diabetes, peptic ulcer disease or reflux, an overactive thyroid, a mental illness or liver or kidney disease. The same applies if you are over 65. Some of these conditions are contraindications to cytisine, while the others require caution and a doctor's decision about treatment.

The restrictions differ slightly depending on the product: Desmoxan, Tabex or Recigar (1, 2, 3).

Why see a doctor before cytisine if you have heart disease or high blood pressure?

Cytisine acts on the same receptors as nicotine, and its effects outside the brain raise blood pressure. A faster heart rate and high blood pressure are very common side effects of Desmoxan, meaning they occur in at least 1 in 10 people. In people taking Tabex, a rise in blood pressure was recorded in 7% of patients. A faster heart rate was recorded in less than 1% of patients in some studies and in as many as 14% in others. In coronary heart disease, heart failure or high blood pressure, the doctor assesses whether treatment is safe, whether blood pressure is well controlled and how often to measure it during the course.

Can you take cytisine several years after a stroke?

A recent stroke is a contraindication. The doctor assesses when the course can be started based on how the stroke progressed, the condition of the heart and blood vessels and the medicines being taken. Someone who takes an anticoagulant after a stroke, such as warfarin, must watch for any bleeding after quitting smoking, in line with the recommendations of the NHS Specialist Pharmacy Service (4).

Can you take cytisine if you have depression or another mental illness?

Mental illness is not a contraindication to cytisine, but it requires caution for two reasons. Quitting smoking, with or without medication, can worsen a pre-existing illness, such as depression. Low mood, rarely with suicidal thoughts, can also be a symptom of nicotine withdrawal. That is why the doctor in charge of psychiatric treatment should know about the plan to quit before the patient sets a quit date, especially as the blood levels of some psychiatric medicines change after stopping cigarettes. If suicidal thoughts appear while you are quitting smoking, you need to tell a doctor about them the same day and not stay alone with them. If such thoughts are persistent or you intend to harm yourself, seek help immediately, without waiting for a booked appointment. We explain how to tell low mood linked to nicotine withdrawal apart from depression in our article on irritability, anxiety and sadness after quitting smoking.

Which medicines act more strongly after quitting smoking?

After quitting smoking, the levels of medicines broken down in the liver by the CYP1A2 enzyme may rise, including theophylline, clozapine, ropinirole and olanzapine. The cause is that you stop inhaling tobacco smoke, not cytisine, so this also applies to people who use nicotine patches to quit, switch to e-cigarettes, or quit without any medication.

Some compounds in tobacco smoke (polycyclic aromatic hydrocarbons) increase the activity of the CYP1A2 enzyme. After quitting smoking, the enzyme's activity falls, and a medicine taken at the same dose reaches a higher level in the blood. According to the NHS Specialist Pharmacy Service (5), the first effects may appear within three days, and it may take two to four weeks for the effect of smoke on the enzyme's activity to wear off completely. Nicotine from a patch or an e-cigarette does not change this, because the breakdown of medicines is sped up by the components of smoke, not by nicotine.

The rise in the levels of these medicines also applies to people who quit smoking during a course of Tabex or another product.

The table is based on the cytisine summaries of product characteristics (SmPCs) (medicines from theophylline to flecainide) and the NHS SPS recommendations, including those on warfarin. The list is not complete: NHS SPS covers 40 medicines, although for many of them the change makes no practical difference.

What should you do before quitting smoking if you take clozapine, olanzapine or theophylline?

Before setting a quit date, you need to tell the doctor who prescribed the medicine about your plan. According to NHS SPS, in people taking clozapine, and where possible also in people taking olanzapine, the doctor orders a blood level test before quitting and repeats it a week later. In people taking theophylline, the doctor may consider gradually reducing the dose in the first week without cigarettes and checking the blood level of the medicine. Do not change the dose yourself. If drowsiness, dizziness, nausea or tremor appear after quitting smoking, you need to contact the doctor who prescribed the medicine. You also need to tell them if you start smoking again, because the levels of the same medicines then fall.

Cytisine should not be used together with tuberculosis medicines.

Do the number of cigarettes and the Fagerström test change the choice of medicine?

During the 25-day course, cytisine is dosed the same way whether someone smokes 10 or 40 cigarettes a day. The dose of nicotine replacement therapy, on the other hand, depends on the degree of dependence. The doctor also takes the degree of dependence into account when choosing treatment.

The degree of dependence is assessed using the Fagerström test. The test has six questions, and the score ranges from 0 to 10 points. The most points, 3 each, are given for the answers to the questions about the time from waking up to the first cigarette and the number of cigarettes smoked a day. We give the questions and scoring on our page about the Fagerström test and assessing nicotine dependence. People with a score of at least 6 points or who smoke more than 20 cigarettes a day are advised to start treatment with Nicorette Classic gum at a dose of 4 mg of nicotine rather than 2 mg (6).

The test score is only one piece of information collected during the consultation. The doctor also asks about previous attempts to quit and how they ended, about other conditions and the medicines you take, and about using e-cigarettes and nicotine pouches alongside smoking cigarettes. Someone who smokes cigarettes and also uses an e-cigarette needs a plan for stopping both sources of nicotine, because during a course of cytisine either of them may increase the side effects of nicotine. We describe how to stop using e-cigarettes in our article on how to quit vaping.

What does research show about support from a doctor or therapist when quitting smoking?

With a specialist's support, more people are still smoke-free at least six months later. In Cochrane reviews, even brief advice from a doctor helped, medication combined with several sessions with a specialist gave better results than usual care, and additional sessions also helped people who were already taking medication to quit.

The point of reference is quitting without any help, meaning without medication or specialist support: 6 to 12 months after one such attempt, 3 to 5% of people who tried to quit on their own are not smoking (7). In the reviews, the result is given as RR, the ratio of the proportion of non-smokers in the group receiving a given form of help to the proportion in the comparison group. An RR of 1.15 means a proportion 15% higher than in the comparison group, not 15 percentage points higher.

• Brief advice from a doctor. In 17 studies comparing brief advice with no advice or usual care, the RR was 1.66. The authors estimate that if 2-3 in 100 people quit without help, brief medical advice helps an additional 1-3 in 100 to do so (8).
• Medication together with support. In 52 studies involving 19,488 people, combining medication with sessions with a specialist was compared with usual care, brief advice or less intensive support. The RR was 1.83, and the certainty of the evidence was rated as high. Specialists usually held 4 to 8 sessions (9).
• More sessions for people already taking medication. In 65 studies involving 23,331 people taking medication, additional support given in face-to-face sessions or by telephone increased the proportion of non-smokers. The RR was 1.15, and the certainty of the evidence was rated as high. The authors estimate that more support increases the chance of quitting by about 10 to 20% (10).

These results come from clinical trials and relate to sessions held in person or by telephone. They do not show the effectiveness of any particular clinic or app.

What is discussed at a consultation before a course of cytisine?

At the consultation before the course, you agree what to do on each day of treatment. The discussion usually covers:

• the quit day, which with cytisine should be set no later than day 5 of the course
• the situations in which you have smoked until now, such as morning coffee, a break at work or drinking alcohol, and what to replace smoking with in these situations
• what to do if you smoke a cigarette during the course
• how to tell the side effects of cytisine from nicotine withdrawal symptoms
• what to do if the course does not help: it should then be stopped, and we write about what to change for the next attempt in our article when cytisine does not work

At Nasz Gabinet, we run a 3-month nicotine dependence treatment plan. It starts with a medical interview about your conditions and the medicines you take. If there are no contraindications, the doctor issues an e-prescription for a medicine chosen after assessment. The Nasz Gabinet app gives you dose reminders, a smoke-free day counter and a diary, and you can also book consultations with a psychologist for a separate fee. If you have heart disease, have had a stroke, are receiving psychiatric treatment or take one of the medicines in the table, the nicotine dependence treatment plan with a medical interview lets you discuss with a doctor, before the first tablet, whether cytisine is suitable in your situation.

How does the cost of a cytisine course compare with spending on cigarettes?

The simplest way is to compare the cost of the course with what you would spend on cigarettes over the same period. Someone who smokes a pack a day would get through 25 packs of cigarettes during the 25-day course of cytisine, and 90 packs over 3 months of treatment.

Multiply the number in the table by the price of the pack you usually buy, and subtract the price of a pack of cytisine at the pharmacy and any consultation fee. You stop smoking by day 5 of the course at the latest, so in practice your savings in the first month are a few packs smaller than the amount calculated from the 25-day column. Someone who uses e-cigarettes or nicotine pouches as well as smoking cigarettes should add their cost separately.

Frequently asked questions

Can cytisine be taken with blood pressure medication?

Take cytisine with blood pressure medication only after consulting a doctor. There are no data on significant interactions with other medicines apart from tuberculosis medicines, but high blood pressure itself requires caution, and raised blood pressure and a faster pulse are very common side effects of cytisine. The doctor checks whether your blood pressure is well controlled and decides how often to measure it during the course.

Can cytisine be combined with fluoxetine or another antidepressant?

Take cytisine with fluoxetine or another antidepressant only after agreeing this with the doctor in charge of your treatment. After quitting smoking, the levels of some antidepressants may rise, including fluvoxamine, imipramine and clomipramine. Quitting smoking can also make depression or anxiety worse, so the doctor should know your planned quit date and how your mood changes in the first weeks.

What should cytisine not be combined with?

Cytisine should not be combined with tuberculosis medicines. From day 5 of the course at the latest, do not smoke at all: smoking or using other nicotine products may increase the side effects of nicotine. Women using hormonal contraception should also use a condom during the course. With theophylline, clozapine and other medicines whose levels rise after quitting smoking, the cause of the rise is that you stop inhaling tobacco smoke, not cytisine itself. That is why their dosing needs to be discussed with a doctor before your quit day. We write about drinking alcohol during the course in our article cytisine and alcohol.

Do you need a prescription for cytisine?

Most cytisine products, including Desmoxan, Tabex and Recigar, do not require a prescription. An e-prescription does not change the medicine or the 25-day course schedule. The difference is that before issuing it, the doctor asks about your conditions, pregnancy and the medicines you take, and may suggest another treatment if cytisine is not safe.

Read more

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Sources

1. Charakterystyka Produktu Leczniczego Desmoxan 1,5 mg, tabletki (Aflofarm), data zmiany tekstu 31.10.2025 [summary of product characteristics, in Polish]. Rejestr Produktów Leczniczych
2. Charakterystyka Produktu Leczniczego Tabex 1,5 mg [summary of product characteristics, in Polish]. Rejestr Produktów Leczniczych
3. Charakterystyka Produktu Leczniczego Recigar 1,5 mg [summary of product characteristics, in Polish]. Rejestr Produktów Leczniczych
4. NHS Specialist Pharmacy Service. Managing specific interactions with smoking. sps.nhs.uk
5. NHS Specialist Pharmacy Service. Considering drug interactions with smoking. sps.nhs.uk
6. Charakterystyka Produktu Leczniczego Nicorette Classic Gum 4 mg [summary of product characteristics, in Polish]. Rejestr Produktów Leczniczych
7. Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction. 2004;99(1):29-38. PMID 14678060, DOI
8. Stead LF, Buitrago D, Preciado N et al. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2013;(5):CD000165. PMID 23728631, DOI
9. Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev. 2016;3:CD008286. PMID 27009521, DOI
10. Hartmann-Boyce J, Hong B, Livingstone-Banks J et al. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database Syst Rev. 2019;6:CD009670. PMID 31166007, DOI