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To fight against smoking, a new medicine reimbursed by Spanish social security was put on the market on 1 February. France, on the other hand, has never adopted this option.
Only 25 days to stop smoking for heavy smokers! This is the promise of Todacitan, a new drug adopted and authorized in Spain since February 1, reimbursed in people who have already tried to quit smoking and who smoke more than 10 a day. Another notable advantage: it would have no side effects. But what is its composition?
Cytisine, a substance “more effective” than nicotine, known since the 60s
The product is however not new in Europe, as elsewhere. Todacitan is composed of cytisine, a substance of plant origin regularly used in Eastern European countries since the 1960s as a treatment to quit smoking. According to a study conducted on more than 1300 volunteers in New Zealand and published in the journal The News England Journal of Medicine in 2014, it would even be more effective than nicotine and its effectiveness no longer needs to be demonstrated. In the countries where it is used, the success rate of this treatment is very high and its side effects are limited to mild to moderate gastrointestinal disorders.
The intake must be followed and distributed in a precise procedure:
- Days 1-3: Six tablets daily (every two hours) while continuing to smoke;
- Day 4 to 12: No more cigarettes, but one tablet every 2.5 hours;
- Day 13 to 25: A steady reduction in treatment until the last day.
Motivation must also be there.
A drug not authorized in France so far
The effectiveness of cytisine no longer needs to be demonstrated and its use is not very restrictive. However, the drug would not be recommendable to everyone and many contraindications surround the molecule: hypersensitivity to the active substance or to the excipients contained in the drug, unstable angina pectoris, recent myocardial infarction, significant arrhythmias, recent stroke. However, cardiovascular fragility is rather common after several years of smoking…
It is also not recommended to use this drug in case of pregnancy and lactation or use of hormonal contraceptives, antiepileptic treatments and antituberculosis treatments.
Is this why the drug has not yet been authorized in France? Henri-Jean Aubin, head of the Addictology research team at INSERM had already spoken out on the subject in 2015. According to him, cytisine is worthy of interest, but another blockage would be at play: “The pharmaceutical industries are not interested in this molecule because it is not very profitable: its marketing in France would only generate low profits.“.
“No molecule is miraculous”
For Alice Denoize, tobacco specialist, this molecule is nothing new. “Cytisine is the same type of product as varenicline, used in Champix, whose characteristic is to block nicotinic receptors. Since nicotine can no longer clip into the reward zone, there is no longer any pleasure felt because there is no more dopamine” she explains.
However, the professional warns:
“There is no miracle molecule, just as there is not 100% success, because it also depends on the person, their motivation and the support put in place or not. The dosage lasts 25 days. Nothing prevents the person from taking a cigarette again on the 26th, if the process is not accompanied.
New drug or not, for the tobacco specialist, stopping the addiction must be undertaken as a whole and act in several stages:
- Take the time to prepare, that is to say to understand why we smoke, what our addiction is, in what context does it appear;
- Take replacement nicotine to avoid physical dependence at first, in order to stay zen to take care of the rest;
- Work to understand your reflexes, the associations, everything that you put behind the cigarette to deal with your conditioning that has sometimes followed you for years.
These three steps can take more than 25 days, but they are effective in the long run.