Cytisine recommended for smoking cessation in two recent Canadian guidelines

Cytisine, a natural health product in Canada, is included as a first-line smoking cessation agent in two recent sets of Canadian smoking cessation guidelines.1,2 The Canadian Task Force on Preventive Health Care smoking cessation guidelines for primary care providers strongly recommend cytisine as one of the preferred interventions for smoking cessation, used alone or in combination with behavioural therapy.1 Updated evidence-based approaches to smoking cessation by the Canadian Cardiovascular Society recommend combination nicotine replacement therapy, varenicline, bupropion or cytisine as first-line pharmacologic therapies.2Cytisine has been safely used in eastern Europe for smoking cessation since the 1960s.3 In Canada, cytisine (1.5 mg capsules, brand name Cravv) is sold as a natural health product (NPN 80072525) by ZPharm.4 The manufacturer recommends the following dosage schedule:1 capsule six times daily (every 2 hrs), with a corresponding reduction in the number of cigarettes smoked for the first three days.Day 4 to 12: 1 capsule every 2.5 hrs (5 capsules daily)Days 13 to 16: 1 capsule every three hrs (4 capsules daily)Days 17 to 20: 1 capsule every five hrs (3 capsules daily)Days 21 to 25 day: 1 or 2 capsules daily.Individuals should reduce the number of cigarettes they smoke gradually over the first few days of treatment and quit smoking by the fifth day of treatment.4The Canadian Cardiovascular Society smoking cessation guidelines note that the manufacturer’s currently approved dosing schedule for cytisine is complex. However, a simplified dosage regimen consisting of cytisine 3 mg three times daily for six or 12 weeks was shown to be safe and effective for smoking cessation in a recent randomized controlled trial.5 The Society notes that this simpler dosage regimen might increase uptake by patients and clinicians.2 The manufacturer indicates that the most common side effects of cytisine seen in clinical trials were nausea, stomach upset and sleep disturbances.4A 2023 systematic review and meta-analysis by McMaster researchers concluded that cytisine is an underrecognized pharmacotherapy for smoking cessation despite available evidence of its efficacy. In their meta-analysis, cytisine showed greater efficacy than placebo and nicotine replacement therapy, but more adverse events. It was found to be comparable in efficacy to varenicline, with fewer adverse events.6References:Thombs BD, Traversy G, Reynolds DL, et al; Canadian Task Force on Preventive Health Care. Recommendations on interventions for tobacco smoking cessation in adults in Canada. CMAJ 2025;197:E846-61. (accessed August 28, 2025).Mir H, Eisenberg MJ, Benowitz NL, et al. Canadian Cardiovascular Society clinical practice update on contemporary approaches to smoking cessation. Can J Cardiol 2025;41:797-812. (accessed August 28, 2025).Karnieg T, Wang X. Cytisine for smoking cessation. CMAJ 2018;190(19):E596. (accessed August 28, 2025).ZPharm. Cravv: the natural way to quit smoking. Frequently asked questions. (accessed August 28, 2025).Rigotti NA, Benowitz NL, Prochaska J, et al. Cytisinicline for smoking cessation: a randomized clinical trial. JAMA 2023;330(2):152-160. (accessed August 28, 2025).Ofori S, Lu C, Olasupo OO, et al. Cytisine for smoking cessation: a systematic review and meta-analysis. Drug Alcohol Depend 2023:251:110936. (accessed August 28, 2025).

Cytisine recommended for smoking cessation in two recent Canadian guidelines

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