Cytisinicline—historically known as cytisine—is a naturally occurring plant-based alkaloid that has been used for smoking cessation in Central and Eastern Europe since World War II. 

Varenicline is the most effective tobacco cessation medication.

Nicotine patches are a first-line intervention in patients who are able to quit smoking at initiation of treatment and who are regular and constant smokers.

The idea of nasal administration of nicotine is appealing in that it more closely approximates the time course of plasma nicotine levels observed after cigarette smoking than other dosage forms; however, the high cost and unpleasant side effects make this difficult to recommend as a first-line treatment, especially since no one form of nicotine replacement therapy has been shown to be more effective than another.

Inhaled nicotine is expensive and can cause unpleasant side effects, both of which make this form of nicotine replacement therapy difficult to recommend as a first-line option since no single therapy has been shown to be more effective than another.

First-line intervention for those patients who can stop smoking at initiation of therapy; nicotine in the form of gum or lozenge may act as a substitute oral activity, which may aid in behavior modification.

DSM-5: “Problematic pattern” of tobacco use leading to “significant distress” that lasts at least 12 months.

DSM-5: “Problematic pattern” of tobacco use leading to “significant distress” that lasts at least 12 months.