As of the next update of the Italian health care system, quitting smoking will have one more therapeutic option at no cost for those who rely on smoke-free centers. Cytisine, an active ingredient of plant origin that has been used for decades in Eastern Europe for smoking cessation, will in fact enter the reimbursability of the National Health Service also for “healthy” smokers, that is, without tobacco-related diseases.
Wider access to therapy
The change is mainly about broadening the scope of beneficiaries. Previously, reimbursability was limited to patients with existing diseases, such as chronic obstructive pulmonary disease and cardiovascular disease. Now the industrial citisin-based drug will also be able to be prescribed in smoke-free centers to those embarking on a cessation pathway without diagnosed clinical complications.
A specific constraint remains, however: free treatment applies only within the structured programs of specialist centers, which include medical monitoring and psychological support. Outside this circuit, the treatment remains fee-based, costing around 90 euros per cycle.
What is cytisine and how does it act
The substance is derived from Cytisus laburnum, a plant in the legume family. It is a naturally occurring alkaloid that acts on the same brain receptors involved in nicotine addiction, specifically the alpha4 beta2 cholinergic receptors.
Its mechanism is twofold: on the one hand, it occupies receptors by reducing the gratification produced by smoking, and on the other hand, it moderately stimulates dopamine production, alleviating withdrawal symptoms. The result is a progressive reduction in the desire to smoke, which according to clinical studies tends to stabilize already after the first few days of treatment.
Brief therapy, progressive effects
It is administered orally and lasts about 25 days, with decreasing dosage. The drug is eliminated almost entirely through the kidneys. The most frequent side effects remain gastrointestinal, particularly nausea and vomiting, which are generally transient.
Used for about sixty years in several European countries, cytisine has already been present in Italy since 2015, but until now it was mostly available as a galenic preparation or under limited access conditions. The move to standardized industrial drug marks a simplification of the therapeutic pathway.
The numbers of tobacco addiction
The decision comes amid a high-impact health context. Smoking remains a leading cause of preventable death: globally, an estimated 6 million deaths per year. In Italy, estimates indicate about 93,000 annual deaths attributable to tobacco, accounting for more than a fifth of male mortality and nearly a tenth of female mortality.
The total economic burden to the health care system and society exceeds 26 billion each year between treatment, lost productivity and care.
Inside the smoke-free centers
Citisin prescription remains linked to a structured medical pathway. Smoke-free centers but integrate behavioral therapies and psychological support, elements considered crucial to increasing the likelihood of success.
According to clinical data cited by specialists, cessation rates can reach 67 percent at three months and remain around 45 percent after one year in patients followed with this combined approach.
One more option in the toolbox
Next to patches, nicotine gum, bupropion, and varenicline, cytisine ranks as a pharmacological alternative with a tolerability profile generally considered favorable. Its more gradual action is often cited as one of the facilitators of therapeutic adherence.
With the new reimbursability, the health care system aims to reduce one of the most prevalent and costly addictions by expanding access to an already well-known but hitherto less widely used therapy.
