Following varenicline's withdrawal, cytisine, a natural plant-based drug used in Eastern Europe for decades, became available in the UK and is considered similarly effective with fewer side effects.

Despite evidence supporting cytisine's efficacy and its availability since January 2024, it remains severely underprescribed in the UK, with only 0.2% of smokers using it, a rate comparable to before it was introduced.

Factors contributing to cytisine's underuse include a shift in public focus towards vaping as a cessation method, misconceptions about its safety and effectiveness, and concerns about its cost.

Low prescribing rates may also be due to cytisine's complex dosing schedule, lack of awareness, cost issues, and some GPs' reluctance to prescribe a newer medication.

With varenicline now reformulated and available again, there is an ongoing debate about whether it should be prescribed by default or if cytisine should be promoted as a first-line treatment for smoking cessation, emphasizing the importance of visibility and acceptance.

The withdrawal of varenicline from the UK market in 2021 due to safety concerns led to an increase in preventable smoking-related deaths, highlighting the need for effective alternatives.

There is a pressing need to increase awareness and confidence among healthcare providers and the public about prescribing and using cytisine, supported by public education, as part of the UK’s broader health strategy.