Varenicline (Chantix): 5 Clinical Facts

Varenicline (Chantix) is indicated for smoking cessation. Which of the following statement is correct regarding Varenicline?

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(1) Dosing Instructions for Chantix:

  • First set a date to quit smoking.
  • Initiate Chantix one week before this quit date. ƒ
  • Take Chantix after a meal and with a full glass of water. ƒ
  • Begin with a dose of 0.5 mg/day for the first 3 days.
  • For the next 4 days: 0.5 mg twice daily (in the morning and in the evening). ƒ 
  • After the first 7 days: increase the dose to 1 mg twice daily (in the morning and in the evening).
  • Total duration of treatment: 12 weeks.
  • An additional 12 weeks of treatment is recommended for successful quitters to increase likelihood of long-term abstinence

(2) When is Dose Adjustment Needed?

Varenicline requires dose adjustment in patients with impaired renal function:

  • Mild to moderate renal impairment: No dosage adjustment is necessary. 
  • Severe renal impairment: recommended starting dose is 0.5 mg once daily. Patients may then titrate as needed to a maximum dose of 0.5 mg twice a day.
  • End-stage renal disease undergoing hemodialysis: maximum dose of 0.5 mg once daily may be administered if tolerated well.

(3) Common Adverse Events seen with Chantix:

(1) Nausea:

  • up to 30% incidence rate (with 1 mg twice daily dosing).
  • usually transient.
  • mild to moderate in severity.
  • Consider dose reduction if not improving in severity.

(2) Insomnia:

  • usually transient.
  • Consider dose reduction if not improving in severity.

(3) Vivid dreams:

(4) Monitor for Neuropsychiatric Adverse Events:

All patients should be observed for neuropsychiatric symptoms including:

  • Changes in mood (including depression and mania)
  • Psychosis (hallucinations or delusions)
  • Hostility, Agitation, Homicidal ideations
  • Anxiety, panic attacks
  • Suicide-related events (ideation, behavior, and attempted suicide). 

NOTE: These neuropsychiatric symptoms can also be symptoms of nicotine withdrawal, including depression & agitation (but rarely suicidal ideations)

IMMEDIATELY STOP CHANTIX IF PATIENT DEVELOPS THESE NEUROPSYCHIATRIC SYMPTOMS. 

(5) Interactions with Alcohol:

According to FDA Drug Safety Communication issued in 2015:

  • Some patients experienced decreased tolerance to alcohol, including increased drunkenness, unusual or aggressive behavior, or they had no memory of things that happened.

Reference:

  • CHANTIX® (varenicline) package insert (PDF)
  • FDA Drug Safety Communication 2015 (FDA)
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Tobacco Use Disorder: Non-Nicotine Medication Options.

This chapter will be summarized in the following sections:

(1) Varenicline.

  • Mechanism
  • Dosing instructions
  • Comparison to Bupropion
  • Effect on Mood

(2) Buproprion SR:

  • Mechanism
  • Dosing instructions
  • As sole pharmacotherapy
  • Augmentation with NRT (Nicotine Replacement Treatment)
  • Comparison with NRT
  • Comparison with Varenicline.

(3) Nortriptyline:

  • Mechanism
  • Dosing instructions
  • As sole pharmacotherapy
  • Augmentation with NRT (Nicotine Replacement Treatment)
  • Comparison with NRT

(4) Which Medications were not found effective for tobacco use disorder?

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