NHS England Relaunches Anti-Smoking Pill Programme with Generic Varenicline and New Cytisine Option
Key Insights
NHS England (search) is reintroducing generic varenicline, a daily pill shown to be more effective than nicotine replacement therapy, after its 2021 withdrawal due to quality issues.
Teva (search)'s generic varenicline could help over 85,000 people attempt to quit smoking annually and prevent up to 9,500 smoking-related deaths over five years, according to UCL research.
Consilient Health (search)'s cytisine, a 25-day course costing £115, launches next week as a new alternative, doubling the chances of quitting smoking compared to existing options.
The NHS is set to significantly expand pharmacological options for smoking cessation in England, with the relaunch of a generic version of varenicline alongside the commercial debut of cytisine, a plant-derived alternative. Together, these developments represent what NHS England (search) describes as a "vital step" in shifting the health service towards prevention, with the potential to help tens of thousands of smokers quit each year.
Generic Varenicline Returns After Four-Year Absence
A new generic version of varenicline — originally sold in the UK as Champix by Pfizer — has been approved for NHS use following clearance by the Medicines and Healthcare products Regulatory Agency (MHRA). The drug, manufactured by Teva (search), had been withdrawn from sale in 2021 after Champix and GSK's Zyban (bupropion) were found to contain potentially toxic contaminants.
Varenicline works by reducing cravings for nicotine and blocking its effect on the brain, while also helping with withdrawal symptoms such as irritability and difficulty sleeping. NHS England (search) states it is more effective than nicotine replacement gum or patches.
NHS chief executive Amanda Pritchard is due to formally announce the decision to make varenicline available alongside behavioural support services at the NHS Providers annual conference in Liverpool, as part of a drive to deliver over £500 million in savings for the taxpayer.
Research by University College London (UCL) suggests that widespread use of varenicline on the NHS could help over 85,000 people try to stop smoking each year, and its use over the next five years could prevent up to 9,500 smoking-related deaths. Meanwhile, a NICE analysis of Champix when it was available found that for every £1 spent on the drug, £1.65 was saved through the prevention of smoking-related illnesses. The generic version is expected to be cheaper, yielding an even greater return on investment.
Cytisine: A New 25-Day Treatment Course
Separately, Consilient Health (search)'s cytisine 1.5 mg tablet — a prescription-only, 25-day course costing £115 — will launch in the UK next week, backed by £70 million ($89 million) in government funding for cessation programmes delivered through primary care.
Cytisine is a nicotine receptor partial agonist based on an alkaloid found in laburnum seeds and has been used for smoking cessation in Central and Eastern Europe for decades. It has been shown to double the chances of quitting smoking and reduces the craving for nicotine. The drug was approved by the MHRA in 2019 but has not been available commercially until now.
The 25-day course compares favourably to the 12 weeks required for Champix and seven weeks or more for Zyban. Cytisine is under review by the National Institute for Health and Care Excellence (NICE) to determine whether it is cost-effective for NHS use.
Dr Richard Russell, a consultant chest physician at King's College London, said cytisine's arrival "provides a new hope for many who have struggled to quit smoking in the past and a clear next step for healthcare professionals helping them." He added: "This is a positive step towards improving the health outcomes of smokers and reducing the burden of smoking-related diseases."
Luke Crosbie, chief executive at Consilient Health (search), commented: "This launch marks a meaningful step forwards in enhancing public health."
The Scale of the Challenge
Smoking is estimated to cost the UK economy up to £17 billion a year, through smoking-related lost earnings, unemployment, early deaths, and costs to the NHS. Smoking-related illness accounts for one hospital admission every minute and up to 75,000 GP appointments each month. Around one in eight adults — six million people in the UK — are smokers.
The programme comes alongside a decision by the Labour government to reintroduce a plan, initially proposed by the previous Conservative administration, to ban anyone born after January 2009 from buying cigarettes, as part of a plan to create a "smoke-free generation."
While Zyban has since been reintroduced by GSK, it remains in limited supply and is not on the preferred medication list. There has been no word from Pfizer on a relaunch of Champix.