Evidence supporting the use of: Alkaloid
For the health condition: Addictions (tobacco smoking or chewing)

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Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Alkaloids, particularly cytisine and varenicline (a synthetic derivative of cytisine), have been utilized as pharmacological aids in supporting smoking cessation. Cytisine, a plant-based alkaloid found in Laburnum anagyroides and other Fabaceae, has a long history of use in Eastern Europe as an aid for quitting tobacco. Scientific studies in the past two decades have validated its effectiveness. Several randomized controlled trials and meta-analyses indicate that cytisine increases the chance of successful smoking cessation compared to placebo (Walker et al., 2014), although its efficacy is somewhat lower than that of varenicline. The mechanism involves partial agonism at nicotinic acetylcholine receptors, reducing withdrawal symptoms and the rewarding effects of nicotine. The evidence rating is 3 because, while there is solid evidence for cytisine and varenicline, not all alkaloids are effective for tobacco addiction, and the evidence for other alkaloids is limited or absent. Additionally, the quality and quantity of studies for cytisine, while significant, are less robust than for some other cessation aids. Nonetheless, cytisine is included in WHO guidelines as a recommended first-line pharmacotherapy for tobacco dependence in some countries. There is little evidence for the use of other alkaloids in treating smokeless tobacco addiction.

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