II. Indications
- Tobacco Cessation
- Not considered first-line therapy in teens who use Tobacco
- Decreases Alcohol consumption (consider for Tobacco Cessation in comorbid Alcohol Abuse)
- Decreases intake by 1 drink daily and 20% fewer heavy drinking days
- Mitchell (2012) Psychopharmacology 223(3):299-306 [PubMed]
III. Precautions
- FDA Pregnancy Category C
- Increased cardiovascular events in Tobacco users with history of cardiovascular disease
- May be used in combination with Nicotine Replacement
- Previously, combined Nicotine Replacement AND Chantix was contraindicated
- Combined Verenicline with Nicotine Replacement is more effective than either alone without increased adverse effects
- Avoid combination with Bupropion
- FDA black box warning was removed in 2017 (but still be aware of potential risk)
- Serious neuropsychiatric symptoms
- May cause depressed mood and Suicidality
- May cause behavior change including hostility, Agitation (especially with Alcohol)
IV. Mechanism
- Nicotine binds Nicotinic Acetylcholine Receptor a4b2
- Chantix activity
- Chantix Blocks Nicotine at a4b2 receptors
- Chantix selectively binds a4b2 receptors
V. Dosing
- Start: 0.5 mg once daily on days 1 to 3
- Next: 0.5 mg twice daily on days 4 to 7
- Next: 1 mg twice daily
- Duration
- Set quit date at 1-5 weeks after starting Chantix
- Continue for 12 weeks
- Additional 12 weeks may be used if successful (but mixed data)
- One study: Higher abstinence rates with delaying quit date to 12 weeks and continuing Chantix for 24 weeks
- One study: No benefit to use longer than 12 weeks
- Dosing adjustment: Renal Impairment
- Severe renal Impairment: Max dose 0.5 mg orally twice daily
- End-stage renal disease: Max dose 0.5 mg orally daily
VI. Adverse Effects
- See precautions above
- Nausea (30%)
- Headache (10%)
- Sleep disturbance (Insomnia, or abnormal dreams): 10%
- Constipation
- Flatulence
-
Seizure
- Typically at 2-3 weeks after starting Chantix
-
Suicidal Ideation
- Reported in 1 per 10,000 patients taking Chantix
- Kuehn (2008) JAMA 299(10):1121-2 [PubMed]
VII. Drug Interactions
-
Alcohol
- Increases risk of Intoxication, hostility, aggressive, Amnesia behavior
VIII. Efficacy
- Cessation for >1 year in 20% (10% with Placebo)
- Cessation rates are as good if not better than Zyban
- ATS preferred agent
- Sustained Smoking Cessation at 6 months (NNT 7)
- More effective when combined with Nicotine Replacement
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Related Studies
| chantix (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| CHANTIX 1 MG CONT MONTH BOX | Generic | $5.87 each |
| CHANTIX 1 MG TABLET | Generic | $5.87 each |
| CHANTIX STARTING MONTH BOX | Generic | $6.28 each |
| varenicline (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| VARENICLINE 0.5 MG TABLET | Generic | $5.80 each |
| VARENICLINE 1 MG CONT MONTH BX | Generic | $4.48 each |
| VARENICLINE 1 MG TABLET | Generic | $5.87 each |
| VARENICLINE STARTING MONTH BOX | Generic | $6.28 each |