Nicotine dependence treatment Wałbrzych

To begin, the patient books an appointment at Nasz Gabinet Wałbrzych at Młynarska 24 or a video call with a doctor. The practice is open 7 days a week from 8:00 to 20:00, so appointments can also be booked at the weekend. No referral is needed, and the appointment costs PLN 250.

To assess nicotine dependence, the doctor asks how long and how much the patient has smoked. The doctor also asks about past and current medical conditions and all medicines the patient takes. On this basis, the doctor chooses a stop-smoking medicine and sets the day of the last cigarette with the patient. The patient leaves with a plan that sets out the name of the medicine, the number of doses on each day and the times to take them. No prescription is needed, because in Poland both cytisine and nicotine medicines in all forms are available without one.

At the same time, the patient meets an addiction therapist, either at the practice on Młynarska or online. A session costs PLN 250, and we write more about these sessions on the page about addiction therapy in Wałbrzych. During treatment, the doctor checks at a follow-up appointment how the patient is tolerating the medicine and whether the dose needs to be changed.

A cigarette brings relief straight away, while the benefits of not smoking show up after months and years. In studies, smokers valued rewards they had to wait for less than other participants did. Researchers call this delay discounting.

At the University of Vermont, 23 smokers, 22 people who had never smoked and 21 former smokers were compared. Participants stated whether they preferred a smaller amount of money straight away or a larger amount paid out after some time. Smokers leaned towards the smaller immediate amount more than the others did. Former smokers chose in a similar way to people who had never smoked. When the reward was cigarettes instead of money, smokers lost interest even faster in the ones they would have had to wait for.

This tendency was also linked with treatment outcomes. In a study of 131 people treated with 6 weeks of cognitive behavioural therapy and 8 weeks of nicotine patches, those who valued delayed rewards less before treatment went back to smoking sooner. The link remained after taking into account the strength of dependence and stress levels. In another study, 48 women stopped smoking during pregnancy, and the same tendency measured at the start predicted which of them would be smoking six months after giving birth.

That is why the addiction therapist does not base conversations with the patient only on diseases that may develop in 20 years' time. Together they set goals for the next few hours and days, for example getting through the first break at work without a cigarette. The patient also writes down changes they notice quickly, such as food tasting better or money staying in their wallet.

Each of the available medicines has several decades of history behind it, and cytisine is the oldest. Effectiveness data come from a review of 319 studies published in 2023 by Cochrane, an international scientific organisation that pools the results of clinical trials and assesses how reliable they are. We checked prices in September 2026.

In the Cochrane review, the effectiveness of medicines was assessed on the basis of not smoking after at least six months. The differences given come from comparing treatment with placebo or no medicine.

Where does cytisine come from?

Cytisine is an alkaloid from plants of the legume family, obtained mainly from laburnum seeds. During the Second World War, plants containing it were used as a tobacco substitute, and in Central and Eastern Europe it has been sold as a stop-smoking medicine for more than 50 years. Today, Desmoxan, Tabex and Recigar tablets are available in Polish pharmacies. Each tablet contains 1.5 mg of cytisine.

In the brain, cytisine binds to the receptors that nicotine acts on and stimulates them more weakly than nicotine does. As a result, the patient feels the lack of nicotine less, and smoking during treatment gives less pleasure than before. At first, tablets are taken 2 hours apart, which means up to 6 a day, and the interval gets longer at each stage, until from day 21 to day 25 just 1 or 2 tablets a day are enough. Smoking must stop by day 5 of treatment. Among 100 people taking cytisine, about 7 more quit smoking than among 100 people given a placebo. A pack of 100 tablets, enough for the whole course, cost from PLN 40 to PLN 78.

How were nicotine gum and patches developed?

The idea for the gum came from two doctors at Lund University, who noticed that submarine crews coped badly with enforced breaks from smoking. The chemist Ove Fernö of the Swedish pharmaceutical company Leo worked on the gum from 1969, the first description in a scientific journal appeared in 1973, and the gum went on sale in 1978. The patch has a shorter history. In 1984, American researchers applied a solution containing 9 mg of nicotine to the forearm of a single volunteer. After half an hour, nicotine was detected in his saliva, his heart rate rose by 15 beats per minute, and for 2 hours the nicotine level stayed similar to that seen when smoking cigarettes.

Pharmacies now sell the NiQuitin Przezroczysty patch, worn around the clock, and Nicorette Invisipatch, removed before going to bed. A new patch is applied once a day, and NiQuitin patches are not used for longer than 10 weeks. The patch increased the number of non-smokers by about 2 per 100. The patient usually reaches for Nicorette Classic Gum, NiQuitin MINI lozenges or Nicorette Spray when nicotine cravings build up. For fast-acting forms of nicotine, the combined result was about 3 extra non-smokers per 100 compared with placebo or no medicine. The daily limit for gum and lozenges is 15. The spray has three limits: 2 sprays at a time, 4 within an hour and 64 within 24 hours. Ten weeks of NiQuitin patches cost from PLN 606 to PLN 930, a 150-dose spray from PLN 62 to PLN 85, and 105 pieces of 4 mg gum from PLN 78 to PLN 100.

What links varenicline with cytisine, and where did bupropion come from?

Researchers at Pfizer began their search for a new medicine with cytisine. Its derivatives did not live up to expectations, so varenicline, first made in 1997, was built on a different molecular framework. It works in a similar way, however, as it also stimulates the same receptors more weakly than nicotine. Among people treated with varenicline, sold as Champix, about 8 more per 100 quit smoking than without medication. In May 2021, a carcinogenic impurity, N-nitroso-varenicline, was found in varenicline tablets in amounts exceeding the limits set by the European Medicines Agency. Batches of the medicine were recalled, which led to shortages of varenicline. In September 2026, none of the pharmacies we checked had Champix.

Bupropion was developed as an antidepressant. In a study published in 1997, 615 smokers took bupropion at one of three doses or a placebo for 7 weeks. After a year, 23.1 percent of people taking 300 mg a day and 12.4 percent of those taking placebo were not smoking. In the review of studies, bupropion increased the number of non-smokers by about 3 per 100. Varenicline and bupropion require a prescription, and the marketing authorisation for Zyban, a bupropion medicine, expired in Poland in December 2023.

Yes. Smokers develop psoriasis more often, and in people who have it, smoking is linked with more severe disease. Psoriasis is a chronic inflammatory disease in which red, scaly patches form on the skin, most often on the elbows, knees, scalp and lower back.

An American study followed 78,532 nurses for 14 years and recorded 887 new cases. Compared with women who had never smoked, the risk of developing the disease was 78 percent higher in smokers and 37 percent higher in former smokers. The more years had passed since quitting, the lower the risk. In the first 10 years after quitting, the risk was 61 percent higher, between 10 and 19 years 31 percent higher, and after 20 years it no longer differed significantly from that of women who had never smoked.

At a dermatology hospital in Rome, 818 patients with psoriasis were examined. In people who smoked more than 20 cigarettes a day, severe disease was more than twice as common as in those who smoked no more than 10. A hospital in Shanghai followed 192 patients treated with biological medicines. After 12 weeks, non-smokers had about a 2.6 times greater chance of a reduction in skin lesions of at least 75 percent. All these studies were observational, so they do not prove that smoking causes these differences.

Psoriasis is not a contraindication to cytisine or nicotine patches, but it affects how they are used. According to the manufacturer's recommendations, the NiQuitin patch is applied only to healthy skin that is not broken, red or irritated. People with atopic dermatitis or eczema should use it with caution. Rash is one of the very common side effects of Desmoxan, which is why a patient with psoriasis tells the doctor about any new skin change.

Yes, to some extent. The Nasz Gabinet app reminds the patient about every dose of medicine prescribed by the doctor, which for cytisine means 6 tablets on the first days and 1 or 2 towards the end of treatment. The patient ticks off a swallowed tablet or an applied patch in the app with a single tap. Once a day, the app randomly picks a dose that the patient records themselves taking on their phone, and medical staff check the video. The patient does not record gum, lozenges or spray, which they use when a nicotine craving strikes.

Medical staff set the reminder times according to the treatment plan. If the reminder times do not suit the patient's day, for example because they get up early for work, the patient can move them. They have 2 days from when the medicine is assigned to do this and can only do it once. The number of doses stays the same. Any further change of times is made by medical staff when the patient contacts us.

The app is free to download, and the treatment programme is paid for. We open access to the programme after an appointment at Młynarska 24, a video call or a phone call, so the first step can simply be calling us.

• We do not recommend sucking glucose tablets instead of taking a medicine. In London, 928 people who were quitting smoking were randomly given glucose tablets or sweet sorbitol tablets and asked to suck at least 12 a day for 5 weeks. All of them had group psychological support, and roughly half also took nicotine medicines or bupropion. Six months without cigarettes were achieved by 14.6 percent of people taking glucose tablets and 13.4 percent of those taking sorbitol tablets, and the difference was not statistically significant. The authors considered the better result for glucose in people also taking medicines to require further research.
• We do not suggest inhaling essential oils instead of smoking a cigarette. In the only study we found, 48 smokers, after a night without cigarettes, inhaled for 3 hours from a device containing black pepper oil, menthol or an empty cartridge. When inhaling black pepper oil, the urge to smoke was lower than in the other groups, but nobody checked whether participants later stopped smoking.

After many years without cigarettes, the risk of heart failure in most former smokers returns to the level of people who have never smoked. Heart failure means that the heart pumps too little blood, which causes breathlessness, getting tired quickly and swollen legs.

An American study followed 4482 people over 65 who did not have heart failure at the start for 13 years. Former smokers who had not smoked for more than 15 years developed it as often as people who had never smoked and did not die more often than them. The exception was people who had previously smoked very heavily, the equivalent of a pack a day for at least 32 years. They developed heart failure 45 percent more often than people with no history of smoking. Even so, they died during the study about a third less often than people who had not stopped smoking.

A patient of Nasz Gabinet Wałbrzych receives support while quitting smoking. The doctor chooses the medicine and adjusts the plan if side effects appear. The addiction therapist prepares the patient for difficult moments. Dose confirmations and recordings go from the app to medical staff. To get started, just call and choose an appointment at our practice at Młynarska 24 or a time for a video call.