The 40-day cytisine treatment for smoking cessation: the Italian experience

Introduction In Eastern Europe, cytisine has been used a lot in smoking cessation while in Italy, it has only recently been introduced, however using a longer treatment schedule consisting of 40 days instead of 25 and a different posology. This work gathered the retrospective observational data collected by some Italian smoking cessation centers that used the 40 day cytisine treatment (40-DCT) and focused on short-term results and possible adverse events. Material and Methods In Italy, cytisine (1.5 mg per tablet) was prescribed as galenical formulation because is not licensed with a specific brand. The dosing regimen was: induction (2 to 6 tablets/ day for the first 7 days), maintenance (6 tablets/day for 7 days), and gradual reduction for 26 days. The 40-DCT was integrated with a behavioral support (5-7 meetings/patient). Demographic and clinical variables of patients were collected at the beginning and at the end of treatment. Results A total of 162 patients (43.2% male) were treated with the 40-DCT, their mean-age was 51.1 years. They smoked 22.6 cigarettes/day and had a mean respiratory CO of 22 ppm at start. The quitting rate at end of treatment was 61%, while 26.0% dropped- out. Among those who continued to smoke (13%), about half of them (6%) halved the number of cigarettes. Nobody interrupted the treatment and only few patients had minor side effects. Conclusions The 40-DCT was effective in tobacco addiction treatment and well tolerated. The vegetal origin and the low cost of cytisine may increase its acceptability and help smokers to quit.