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Stop Smoking Drug

Varenicline Quit Smoking Pills

The stop smoking drug Varenicline (trade names Chantix and Champix) is a prescription quit smoking medicine, in the form of a pill, that is used to treat nicotine addiction.

How does it work?

This stop smoking drug "binds to the nicotine receptors in the brain, and blocks them so that nicotine cannot bind to them. The reward of nicotine is reduced because nicotine can no longer stimulate the pleasure center by raising the dopamine level in the brain. This helps reduce cravings for cigarettes. It also seems to help reduce withdrawal symptoms when smokers quit".1

Suggested Use

Varenicline quit smoking pills should be taken whole, after a meal, with a full glass of water.

Typical Dosage

A single 0.5mg pill is taken for the first three days. Dosage in then doubled for the next four days: one 0.5 mg pill should be taken each morning and each night.

During the second week the dosage is doubled yet again. Typically one 1mg pill is taken each morning and each night. Most people will take CHANTIX for up to 12 weeks. If you have completely quit smoking by 12 weeks, your doctor may prescribe CHANTIX for another 12 weeks to help you stay cigarette-free.2

Ingredients

Active ingredient: Varenicline Tartrate

Inactive ingredients: microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, colloidal silicon dioxide, magnesium stearate, Opadry ® White (for 0.5 mg), Opadry ® Blue (for 1 mg), and Opadry® Clear (for both 0.5 mg and 1 mg).

Side Effects

Some people have nausea and trouble sleeping at first, which usually goes away on its own.

Some people have reported emotional changes such as depressed mood, agitation, changes in behavior (including hostility and aggressiveness), suicidal thoughts, and even suicide while using varenicline to try and quit smoking.1

Clinical use of varenicline (FDA approved)
Patient selection
  • Appropriate as a first-line medication for treating tobacco use.
Precautions, warnings, contraindications, and side effects (see FDA package insert for complete list)
  • Pregnancy – Pregnant smokers should be encouraged to quit without medication. Varenicline has not been shown to be effective for treating tobacco dependence in pregnant smokers. (Varenicline is an FDA pregnancy Class C agent.) Varenicline has not been evaluated in breastfeeding patients.

  • Cardiovascular diseases – Not contraindicated.

  • Precautions – Use with caution in patients with significant kidney disease (creatinine clearance < 30mL/min) or who are on dialysis. Dose should be reduced with these patients. Patients taking varenicline may experience impairment of the ability to drive or operate heavy machinery.

  • Warning – In February 2008, the FDA added a warning regarding the use of varenicline. Specifically, it noted that depressed mood, agitation, changes in behavior, suicidal ideation, and suicide have been reported in patients attempting to quit smoking while using varenicline. The FDA recommends that patients should tell their health care provider about any history of psychiatric illness prior to starting this medication, and clinicians should monitor patients for changes in mood and behavior when prescribing this medication. In light of these FDA recommendations, clinicians should consider eliciting information on their patients’ psychiatric history.

  • Side effects – Nausea, trouble sleeping, abnormal/vivid/strange dreams.
Dosage
  • Start varenicline 1 week before the quit date at 0.5 mg once daily for 3 days, followed by 0.5 mg twice daily for 4 days, followed by 1 mg twice daily for 3 months. Varenicline is approved for a maintenance indication for up to 6 months. Note: Patient should be instructed to quit smoking on day 8, when dosage is increased to 1 mg twice daily.
Availability
  • Prescription only.
Prescribing instructions
  • Stopping smoking prior to quit date – Recognize that some patients may lose their desire to smoke prior to their quit date or will spontaneously reduce the amount they smoke.

  • Dosing information – To reduce nausea, take on a full stomach. To reduce insomnia, take second pill at supper rather than bedtime.
Costa
  • 1 mg, box of 56 = $131 (about 30-day supply).
Source: Treating Tobacco Use and Dependence: 2008 Update. (Fiore et al, 2008)

aCost data were established by averaging the retail price of the medication at national chain pharmacies in Atlanta, GA, Los Angeles, CA, Milwaukee, WI , Sunnyside, NY, and listed online during January 2008 and may not reflect discounts available to health plans and others.

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References

  1. ACS :: Cancer Drug Guide. Varenicline. July 2009. Available at http://www.cancer.org/docroot/CDG/content/CDG_Varenicline.asp (accessed on 26 July 2009).
  2. Psifer Labs, MEDICATION GUIDE CHANTIX. 2009. Available at http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088569.pdf (accessed on 26 July 2009).
  3. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.