Stop-smoking pill varenicline to be offered on NHS – what you need to know

For the first time since 2021, a pill used to help people quit smoking – varenicline – will again be available on the NHS.

Varenicline is one of the most effective ways to quit smoking and is deemed an “essential medicine” by the World Health Organization.

What is this “new” smoking cessation pill?

Varenicline, is a once-a-day pill that was first available in 2007. It was withdrawn in 2021 after testing revealed higher-than-permitted impurities in certain batches.

These impurities are called nitrosamines and are in food, drink and medicines, but are not allowed to be over a certain level in these products. This is because animal testing has indicated that nitrosamines could be linked to cancer in humans if they are exposed above certain levels over long periods.

Now, a new version of varenicline has been approved for use by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA), and it will be available once again through the NHS.

How does it work?

Varenicline belongs to a group of drugs known as “nicotine receptor partial agonists”. It works by blocking the addictive nicotine in cigarettes from binding to receptors in the brain, reducing the pleasurable effects of smoking.

At the same time, it acts on these brain receptors to ease withdrawal symptoms and lower cravings to smoke. This makes quitting more manageable. By reducing cravings and the rewarding effects of nicotine, varenicline increases the chances of successfully quitting smoking.

How effective is it?

For every 100 people using varenicline, about 12 to 16 successfully quit, compared with around six in 100 who manage to quit without any aids. This means that varenicline can double, or even triple, a person’s chances of quitting.

How does it compare with other smoking cessation treatments?

Varenicline isn’t the only option to help people stop smoking in the UK. Evidence suggests that nicotine vapes help about ten to 19 people per 100 quit. Using two types of nicotine replacement therapy together, such as a patch with gum, also gives similar results.

Using a single type of nicotine replacement therapy, such as patches or gum on their own, and another medication called bupropion, are a bit less effective, helping around eight to nine people per 100 quit.

Are there any side-effects?

As with all drugs, varenicline can have side-effects. Common non-serious side-effects include nausea, trouble sleeping, vivid dreams and changes in mood. Previously, there were concerns that varenicline could cause thoughts of suicide or suicidal behaviour. However, a large, well-conducted study found no evidence of this.

How many lives might it save?

Having access to varenicline for quitting smoking could have a huge effect on the health of the public. Smoking is uniquely deadly, with at least one in every two people who smoke dying of smoking-related disease.

NHS England estimates that varenicline could help more than 85,000 people quit smoking each year, potentially preventing up to 9,500 smoking-related deaths annually.

The benefits of quitting start almost immediately: within minutes heart rate can drop to healthier levels and within just a few years of quitting, the risk of heart disease is cut in half. Overall health continues to improve beyond this.

There are more ways to quit smoking than ever before, from nicotine vapes to pill-based medications. All of these quitting aids work best when combined with counselling.

While it can take several attempts to quit, many people who have tried unsuccessfully eventually manage to stop smoking for good.

In the UK, support to stop smoking is available at www.nhs.uk/better-health/quit-smoking/. Accessing these services can make quitting easier and more successful.

Angela Wu receives research funding from Cancer Research UK, Greater Manchester Integrated Care and Clarion Futures charitable foundation. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the funders.

Nicola Lindson receives research funding from Cancer Research UK, the National Institutes for Health, NHS Greater Manchester Integrated Care, Clarion Futures charitable foundation, the Oxford and Thames Valley NIHR Applied Research Collaboration, Oxfordshire County Council. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the funders.