Lithuanian Smoking Cessation Drug Offers Hope, But Not Yet in Finland

Mikko Waltari, 59, ended a 30-year, pack-a-day smoking habit six years ago with the help of cytisine, a drug he found readily available without a prescription at a pharmacy in Lithuania. Waltari had tried quitting multiple times before, but the familiar withdrawal symptoms, sweating, tremors, nightmares, and intense psychological cravings, always proved too much.

"The medication reduced withdrawal symptoms by at least 80 percent," Waltari stated, highlighting its particular effectiveness against the mental anguish of quitting. "The psychological anxiety disappeared immediately after taking the medicine."

Cytisine, an extract from the seeds of the golden rain tree, has been used in Eastern Europe for decades to aid smoking cessation. A month's supply cost Waltari about 35 euros in Lithuania, prompting him to question why such an effective and affordable treatment wasn't available in Finland.

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The medication reduced withdrawal symptoms by at least 80 percent.

According to Finland's pharmaceutical regulatory authority, Fimea, a company did apply for and receive a marketing authorization for cytisine under the trade name Cysarax in early 2025. However, the drug is not yet on the market. Fimea's chief medical officer, Pauliina Ikäheimo, explained that the decision to launch rests solely with the marketing authorization holder, a pharmaceutical company that did not respond to inquiries from HS. If Cysarax eventually reaches the market, it will likely require a prescription initially, a standard practice in Finland for new medications to allow for better monitoring of potential side effects.

In Finland, smoking cessation often relies on nicotine replacement therapies, which can lead to their own dependencies. Non-nicotine medications typically require a prescription. Common prescription treatments in Finland include varenicline and bupropion, but Waltari found their reported side effects, such as nausea, headaches, and sleep disturbances, too concerning to try. He reported no side effects from cytisine himself.

Kaarlo Simojoki, director and chief physician of Mehiläinen's addiction services, views cytisine as an interesting alternative for nicotine withdrawal. He noted that U.S. studies on cytisine support Waltari's experience of fewer side effects and easier withdrawal symptom management. Simojoki also pointed out that severe side effects from currently available medications are rare and individual experiences vary, which could explain Waltari's perception of cytisine's specific benefit for psychological symptoms.

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The psychological anxiety disappeared immediately after taking the medicine.