Nicotine dependence treatment Kraków

Nicotine dependence, also called nicotine addiction, is a disease described by the World Health Organization in the ICD-10 classification under code F17.2 and in ICD-11 under code 6C4A.2. Nicotine stimulates nicotinic receptors in the brain and increases the release of dopamine, and with daily smoking the brain adapts to its constant presence. When nicotine is missing, withdrawal symptoms and cravings appear. How strong the dependence is depends on factors such as genes, the age at which a person started smoking and how fast the body breaks down nicotine.

According to twin studies, genes account for at least half of the differences in how people smoke, including how strongly dependent they are and how many cigarettes they smoke a day. The risk of dependence rises when someone starts smoking early, and in the United States 80 percent of smokers started before the age of 18.

The liver enzyme CYP2A6 breaks down nicotine. People in whom it works more slowly smoke fewer cigarettes a day, while those who break down nicotine quickly have stronger withdrawal symptoms and are less likely to quit with patches. On average, women break down nicotine faster than men, and their smoking is more strongly linked to situations and mood, which may help explain why quitting can be harder for women. We do not test genes or the rate of nicotine metabolism. The doctor selects medication and dose according to craving severity and previous attempts to quit.

Quitting smoking protects the heart and blood vessels even if the patient gains weight. In the US Framingham Study, the typical weight gain in people without diabetes who had quit smoking in the previous 4 years was 2.7 kg. Even so, their risk of heart and blood vessel disease was less than half that of people who kept smoking, and taking the weight gain into account hardly changed this result. In people with diabetes the risk was also lower, but the difference was not statistically significant.

Patients in Kraków do not have to quit alone. The doctor chooses medication and checks how well it is tolerated, while the app provides dose reminders. Those who purchase the treatment plan also work with an addiction therapist to prepare for difficult days. Patients with obesity can receive treatment for it at the same clinic.

Quitting without any help succeeds least often. In a review of studies of smokers who tried to quit on their own, most went back to cigarettes within the first 8 days, and after six months or a year only 3 to 5 percent of them were not smoking.

A medicine reduces cravings in the first weeks, when relapses are most common. In a summary of 319 studies, 13 percent of people treated with cytisine and 6 percent of people in groups that did not receive medication were not smoking after six months.

More people stop smoking when medication is combined with specialist support. A 2019 review included 83 studies in which all participants took stop-smoking medicines. Additional support through face-to-face meetings or telephone calls increased the proportion who quit. This conclusion was rated high certainty. The treatment plan in Kraków therefore combines medication selected by the doctor with 10 addiction therapy sessions in the app.

Can quitting smoking cause anger or aggression?

Yes. Anger, impatience, anxiety, low mood, difficulty concentrating and insomnia are all symptoms of nicotine withdrawal. They are strongest in the first week without cigarettes and usually pass after 2 to 4 weeks.

In a small laboratory study, men who were heavily dependent on nicotine and had not smoked for several hours reacted aggressively more often in a computer task in which another participant supposedly took points from them. After chewing nicotine gum, they reacted the same way as on a day when they smoked, while gum without nicotine did not reduce this reaction. In a review of studies on gum and other oral forms of nicotine, all 9 studies that assessed irritability in the first week without cigarettes showed that nicotine in this form reduces it.

Before the quit date, the patient can warn family and colleagues that they may lose their temper more easily in the first weeks. In a session with an addiction therapist, they decide what to do when anger builds up, for example leave the room for a moment or put off a difficult conversation. If anger is very strong despite the medicine, the patient tells the doctor, who assesses whether the dose is sufficient. A patient who is losing self-control or thinking about harming themselves or someone else needs urgent medical help.

Treatment starts with a medical consultation at Nasz Gabinet in Kraków, ul. Siewna 4/5 in Prądnik Biały, or remotely by video in the app. Both treatment options are purchased in the app. The Anti-Nicotine Course costs PLN 350 and includes the consultation with an e-prescription. The Anti-Nicotine Treatment Plan costs PLN 2499 and includes a consultation, prescriptions for 3 months of medication and 10 addiction therapy sessions. Neither price includes medicines purchased at the pharmacy. No referral is needed. Patients do not have to stop smoking before the appointment, as the date of the last cigarette is set after the treatment approach has been chosen.

At the appointment, we ask how many cigarettes the patient smokes a day and what medicines they take regularly. The dose of the nicotine patch depends on the number of cigarettes. We ask women of childbearing age about contraception, because during a course of cytisine they must use an effective method to prevent pregnancy. We explain to patients with type 2 diabetes how quitting smoking can change their blood sugar, and we tell patients who are worried about gaining weight how many kilograms people put on, on average, in the first year without cigarettes.

The appointment ends with treatment instructions specifying a quit date. If the doctor selects medication, the instructions also include its name and the date to start taking it.

The table lists examples of stop-smoking products, not all of them.

How do cytisine, varenicline, nicotine and bupropion work?

Cytisine and varenicline bind to nicotinic receptors in the brain and stimulate them more weakly than nicotine. In this way they ease cravings, and a cigarette smoked during treatment does not give the smoker the same pleasure. From a patch, nicotine is absorbed through the skin evenly over 24 or 16 hours, while from gum, spray and lozenges it is absorbed faster through the lining of the mouth, so patients use them when a sudden urge to smoke comes. Bupropion blocks the reuptake of noradrenaline and dopamine, which means these substances, which carry signals in the brain, stay between nerve cells for longer. According to the manufacturer of Zyban, however, it is not known exactly how the medicine helps people stop smoking.

Does cytisine work better than nicotine patches and gum?

Cytisine was compared with nicotine in a New Zealand study of 1,310 smokers. Half of them took cytisine for 25 days, and the other half used patches together with gum or lozenges for 8 weeks. After one month, 40 percent of people treated with cytisine and 31 percent of those treated with nicotine were not smoking, and cytisine's advantage was still there after six months. People taking cytisine reported side effects more often, mainly nausea, vomiting and sleep problems.

In the same study, cytisine's advantage was clear in women, while in men cytisine proved at least as effective as nicotine. It is not known whether cytisine weakens the effect of contraceptive pills and other hormonal contraceptives that act throughout the body, so a woman using them during a course of cytisine also uses a condom or another barrier method. Cytisine is not taken during pregnancy or breastfeeding, and in that case the doctor decides on nicotine in the form of a patch or gum.

Does cytisine work as well as varenicline?

An Australian study of 1,452 smokers compared a 25-day course of cytisine with a 12-week course of varenicline. For six months without a break, 11.7 percent of people treated with cytisine and 13.3 percent of those treated with varenicline did not smoke, and the study did not show that cytisine works at least as well as varenicline. People treated with cytisine reported side effects less often. In practice, however, a patient in Kraków chooses between cytisine and nicotine, because in September 2026 we did not find Champix in the pharmacies we checked, and the marketing authorisation for Zyban expired in December 2023.

Does a patch combined with gum work better than a single form of nicotine?

Nicotine itself can be used in several forms. In a 2023 review of 68 studies on doses and forms of nicotine, 16 studies involving 12,169 people compared a patch combined with gum, spray or lozenges with a single form of nicotine. After six months or longer, 27 percent more people using the combination were not smoking, and the authors rate the certainty of this result as high. In the earlier, 2019 version of the review, 4 mg gum worked better than 2 mg gum, although the benefit probably applied only to strongly dependent people. No difference in effectiveness was shown between a patch alone and gum or lozenges alone.

Prescription and price of stop-smoking medicines

Most cytisine products and all forms of nicotine are sold without a prescription, while Champix, like Zyban before it, requires a prescription. A course of cytisine costs about PLN 40 to 78, and a 10-week course of 24-hour patches about PLN 606 to 930. None of these medicines is reimbursed by Poland's National Health Fund (NFZ).

At Nasz Gabinet in Kraków, the doctor and addiction therapist have different roles. The doctor assesses withdrawal symptoms, selects nicotine replacement therapy or cytisine, agrees follow-up dates individually and provides support particularly while the patient is quitting. The therapist helps patients change habits, manage emotions and strengthen their motivation to stop smoking. Therapy is part of the treatment plan: 10 sessions, all held by video in the Nasz Gabinet app.

In the first sessions, patients explore their own reasons for stopping and discuss what is holding them back. Motivational interviewing is one tool used in this work. Patients also learn to understand their dependence: the situations, times and reasons that lead them to reach for a cigarette. Next, they prepare for the quit date. The doctor sets it according to the medication, for example no later than day 5 with cytisine, while the patient and therapist plan what to do when cravings occur.

Later work addresses everyday life without cigarettes. Patients change routines and learn to manage stress and anger, which nicotine withdrawal can intensify during the first weeks. Those worried about weight gain can discuss it in a session and plan lifestyle changes. Later, they maintain new habits, begin to see themselves as non-smokers and prepare for a possible lapse to avoid returning to regular smoking. Cochrane, an independent international research organisation, reviewed 312 studies. The review found that talking with a therapist increased the proportion of people who were not smoking after six months or longer, including those taking stop-smoking medication.

The Nasz Gabinet app reminds patients to take their medicine according to their treatment instructions. It sends a reminder before each cytisine dose, or every morning for patches. Patients can see the current treatment day and the time of their next dose, and from the quit date also the number of smoke-free days.

The app does not change medication or doses. Patients who feel unwell during treatment discuss this with the doctor at an appointment booked in the app. It can take place by video without travelling to Siewna. Sudden, severe symptoms require urgent medical help. Patients purchase a course or treatment plan in the app; both provide access to the stop-smoking programme. Nasz Gabinet in Kraków can help with purchasing and installation.

• We do not use hypnosis as a way to quit smoking. An analysis of 14 studies involving 1,926 people did not settle whether hypnosis helps more than other forms of support or quitting without help, and if it brings any benefit, the authors say it is small at most.
• We do not recommend fasting or diets under 1200 kcal to people who have gained weight after quitting smoking. In a 2021 summary of studies, a very low calorie diet in which all normal meals were replaced with special products limited weight gain by the end of treatment, but in the study that checked weight after a year, the difference was no longer significant.

Most people put on weight after quitting smoking, on average a few kilograms in the first year. In an analysis of 62 studies, people who quit without medication weighed an average of 1.1 kg more after a month and 4.7 kg more after a year than before quitting. After a year, 37 percent of them had gained less than 5 kg, 34 percent 5 to 10 kg and 13 percent more than 10 kg, while 16 percent had lost weight.

A 2021 summary of studies found no evidence of moderate certainty that any method limits weight gain after quitting smoking beyond the end of treatment. Weight loss support tailored to the individual patient reduced weight gain by about 1 kg by the end of treatment, but after a year no difference was shown. General dietary advice, without a plan designed for the patient, was not shown to reduce weight gain. Low-certainty evidence suggests, however, that such advice may have reduced the proportion of people who quit smoking. Nicotine replacement therapy reduced weight gain by about half a kilogram by the end of treatment.

For patients with obesity, we offer obesity treatment in Kraków alongside quitting, at the same practice on Siewna. There, a dietitian draws up the meal plan, without fasting and without diets under 1200 kcal.

How do blood sugar levels change in people with type 2 diabetes?

A UK study included 10,692 smokers with type 2 diabetes. In people who quit and stayed off cigarettes for at least a year, glycated haemoglobin (HbA1c), a measure of average blood sugar over recent months, rose by an average of 0.21 percentage points in the first year. In the following years without cigarettes, the result went down, and after 3 years it was similar to that of people who kept smoking. The rise in HbA1c was not explained by weight gain.

The manufacturers of nicotine gum and patches advise people with diabetes to check their blood glucose more often after quitting, and cytisine is used with caution in diabetes. That is why we advise patients with type 2 diabetes to check their blood sugar more often during treatment and to tell the doctor who treats their diabetes the date they stopped smoking.