Tabex for Smoking Cessation: One More Tool for Smokers Trying to Quit
Tabex was reported in the prestigious New England Journal of Medicine to be more effective than placebo for help in quitting smoking. Sounds great until you read the actual numbers. Tabex was shown in a single fairly small study including only 740 patients that was conducted in Poland to have a 1 year success rate of 8.4% as compared to a 2.4% success rate with placebo. Admittedly this sounds like it is helpful in a small percentage of patients, but at best only about 1 in 12 patients using Tabex will be successful in quitting smoking.
Still having an inexpensive and over the counter product patients can use to try to get help in quitting smoking is exciting. Studies show that most smokers would like to quit smoking. Smoking rates have decreased significantly in the United States over the last couple of decades, but many patients in my practice just cannot seem to quit smoking. Chantix has been quite helpful for many patients, but significant Chantix side effects including cardiovascular concerns, vivid dreams, depression and even suicidality have been deterents to Chantix use. The high price of Chantix is also a major deterrent to widespread use. Bupropion, originally marketed as Zyban for smoking cessation, is sometimes helpful, but far from a panacea.
Tabex, chemical name cytosine, is structurally similar to nicotine, and functions as a nicotinic acetylcholine receptor agonist. It is an extract of the seeds of Golden Rain acacia (Cytisus laborinum) and Chantix is actually a derivative of cytosine and has been approved for smoking cessation in the U.S. since 2006. Tabex has b een used in Europe for nearly 40 years for smoking cessation and has been produced by a Bulgarian company Sopharma AD.
In the NEJM study Tabex was used on a 25 day tapering schedule, taking 6 tablets daily for the first 3 days, five tablets on days 4-12, and then tapering more quickly by taking 4 days on 4/day, 4 days on 3/day, until stopping on day 25 after 2 days of two tablets daily. At this dose toxicity seemed minimal, although the authors admit the study was too small to find uncommon adverse effects of Tabex. Cytisine has been documented to have serious side effects at much higher doses, so users should not take more than this regimen used in the NEJM study.
Tabex appears to be inexpensive, on E-bay I found vendors selling #100 1.5 mg tablets for $13.35 USD. This would amount to enough pills for a person to take the recommended 25 day regimen and have just a few pills left over. This compares to Chantix which costs about $179/ month at Drugstore.com.
This small NEJM study implies that this inexpensive, seemingly fairly safe drug, available without a prescription, is marginally effective for helping smokers quit the habit. I think it may be worth a try for smokers who have been unable to quit using nicotine replacement systems, cannot tolerate, cannot afford or have reasons not to use Chantix, and are motivated to quit. The long term adverse health effects of continuing to smoke seem to far outweigh the risks of essentially all of the smoking cessation aides for patients without specific contraindications to their use.
In European use for over 40 years there does not seem to have been much in the way of serious problems with Tabex use, and I anticipate the use of Tabex to increase significantly in the U.S since the NEJM article has given more validity to its use.
There is really little to no evidence that the other SSRI drugs like citalopram or sertraline help patients to quit smoking.
The abstract of the NEJM article is available here.