For 45 years Tony Murphy was a solid 20-a-day smoker. His occasional attempts at quitting lasted at best days, often only hours, as his craving for a cigarette was so strong.
But the father-of-five has not had a cigarette now for six months – and hasn’t had a single pang to return to his former habit.
And it’s all thanks to a newly available drug being hailed by some as the Ozempic for smokers.
Tony knew the need to quit was becoming more urgent: a long-time chronic cougher, last summer he was driving to work when he was seized by a bout of coughing so violent his head started spinning.
Fearing he was going to faint, the 61-year-old had to rapidly pull over at the side of the road near his home in Stockport.
‘It was really scary,’ says Tony, who works as a quiz host and DJ.
He later learned the dizziness, which had happened a couple of times before, was triggered by severe coughing caused by a sharp drop in blood pressure – so less oxygen reached his brain. It was the wake-up call Tony needed to try again to quit his smoking habit.
‘I was feeling anxious and was worrying if the smoking had already done lasting damage,’ he says.
Tony, 61, had tried every form of quitting – often lasting only hours – but cytisine stopped his cravings to the point where he can be around people smoking and it doesn’t bother him
Around one in eight adults, about six million people, in the UK smoke and it can have a huge toll on their health.
It is the leading cause of preventable illness and deaths, linked to seven in ten lung cancers and increases the risk of many other major conditions, such as strokes, type 2 diabetes, heart disease and dementia.
Tony says this time ‘I was really ready to quit’ – then he spotted a poster for a smoking cessation clinic, booked an appointment with the service, and was offered the prescription-only drug, cytisine.
Cytisine, which comes as a tablet, works by curbing cravings and the enjoyment of cigarettes – just as weight-loss jabs such as Ozempic curb the desire for food. Last month cytisine was approved for use on the NHS.
‘It’s been amazing,’ said Tony, who has two adult children and three boys aged 16, 13 and 12.
‘I have tried to quit lots of times before and always failed, but this tablet made all the difference.’
Tony, who started smoking aged 14, had tried everything from just stopping smoking, to using nicotine replacement patches and gum, and the daily pill varenicline, then known as Champix, which is also available on the NHS.
Like cytisine, it works by reducing the urge to smoke by attaching to some of the same receptors in the brain that nicotine does.
Both drugs have a success rate of our around 14 per cent – but cytisine works quicker.
Professor Matthew Evison, a consultant chest physician at Manchester University NHS Foundation Trust says: ‘I see it having a really positive impact on patients in my clinic.’
As Tony’s previous attempts at quitting often lasted less than a day, despite being desperate to quit, he wasn’t convinced cytisine would work.
Cytisine, a tablet approved by the NHS last month, works by curbing cravings and the enjoyment of cigarettes – just as weight-loss jabs curb the desire for food
Professor Matthew Evison, a consultant chest physician, says: ‘I see it having a really positive impact on patients in my clinic’
‘When I was hosting quizzes in pubs I would always pop out during a break for a cigarette and chat to the other smokers.’
‘Smoking was just part of my life,’ he says.
‘When I got up I would have a smoke outside with a coffee, then after dropping my boys at school I would have another.’
He started taking cytisine last September.
The medication, which costs the NHS £115 for a standard 25-day course, is based on a molecule similar to nicotine but derived from the laburnum tree.
During World War II, soldiers who ran out of tobacco would smoke the leaves from a laburnum, which they found curbed their cravings, says Professor Evison, who is also clinical lead for Manchester’s Make Smoking History service.
Cytisine attaches to the same receptors in the brain where nicotine usually docks to release the feel-good chemical messenger dopamine.
This means people taking the drug feel like they have smoked a cigarette – and don’t experience withdrawal symptoms, which can include intense cravings for nicotine, irritability, anxiety and anger.
If someone smokes while on the tablet, it also reduces the amount of dopamine produced, drastically reducing the sense of pleasure people get from smoking, because so many of the receptors are already blocked by the cytisine.
Treatment starts with six tablet a day, one every two hours.
You are meant to stop smoking on day five and the number of tablets is gradually tapered down over the 25 days.
Rates of side-effects on cytisine are generally low but include appetite changes, disrupted sleep, vivid dreams and nausea, says Professor Evison.
But he adds: ‘Cytisine can make a huge difference. It’s cheap, effective and well-tolerated with low side-effects.
‘We’ve now got a range of really effective treatments to help people stop smoking, and that is important because it often takes people many attempts to finally become truly smoke free.
‘The more options we’ve got, the more people we can help.’
He adds: ‘There is no single bigger change that someone can make for their health than give up smoking,’ he says.
‘It damages every single organ in the body and kills two out of three people who do it.’
In February the National Institute for Health and Care Excellence (NICE) added cytisine to the package of support available on the NHS in England to help people quit.
The other support available includes seeing a counsellor for stop-smoking support; nicotine replacement therapy such as patches and gum; and a pill called bupropion, which was developed for depression but is believed to work on the part of the brain involved with addiction.
Vapes are also backed by NICE as a safer alternative to smoking.
An analysis of 300 studies involving 150,000 smokers by the leading research organisation Cochrane in 2023 found that vapes, varenicline and cytisine were the aids most likely to help people quit smoking.
For every 100 people trying to stop, around 14 are likely to succeed with these approaches, compared to six in 100 who are likely to quit without using any aids.
Varenicline, which works in in a similar way to cytisine, was originally launched in the UK as Champix in 2007, but is a 12-week course.
Concerns were raised about its safety in relation to heart attacks and mental health effects in the past, but Professor Evison says these have been disproved by more recent research.
Champix was withdrawn in the UK in 2021 over concerns after an impurity was discovered in the pills, according to NHS England.
A generic version of the product was relaunched on the NHS last year after being approved as safe by the Medicines Healthcare products and Regulatory Authority.
Currently there is a postcode lottery over how easy it is to access these prescription-only treatments around the country, says Professor Evison.
Different areas choose which treatments they want to fund, and some smoking cessation services won’t include staff who can prescribe medication.
Professor Nick Hopkinson, medical director at charity Asthma + Lung UK said stop smoking services nationally had been ‘decimated in recent years’.
Yet he adds: ‘You are three times more likely to quit smoking successfully if you have a combination of counselling support and treatment, helping to relieve cravings and break tobacco dependence’.
While initially cynical about how much difference cytisine would make for him, Tony says he was pleasantly surprised by the difference it made.
‘I didn’t have cravings this time,’ he said. ‘In the past when I tried to quit, whenever I smelt smoke, I would want a cigarette, but it didn’t happen this time. I can be around people smoking and it doesn’t bother me.’
For Tony, the only side-effect was disrupted sleep.
‘I don’t sleep well anyway, but it was even worse when I was taking the tablets,’ he says.
Within a few weeks his chronic cough improved and his energy levels soared.
‘I walk around a lot when hosting quizzes, but sometimes found that I would get breathless as I spoke, but I don’t have that anymore,’ he says.
Tony can now carry heavy DJ equipment easily up flights of stairs without gasping for breath. And he no longer coughs himself to sleep at night.
He is also saving around £400 a month by not buying cigarettes and treated himself to a new watch he wouldn’t previously have been able to afford.
‘I was walking up the stairs at a multi-storey car park recently and chatting to someone at the same time – when I was smoking I had to either speak or breathe,’ he says. ‘It’s had a superb impact on my health.’
