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Chantix
Aka: Chantix, Varenicline
- 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]
- Precautions
- FDA Pregnancy Category C
- Increased cardiovascular events in Tobacco users with history of cardiovascular disease
- http://www.fda.gov/Drugs/DrugSafety/ucm259161.htm
- 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
- Koegelenberg (2014) JAMA 312(2):155-61 [PubMed]
- Avoid combination with Bupropion
- Safety in combination with Bupropion is unknown
- However, both agents increase risk of Seizures
- 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)
- Mechanism
- Nicotine binds nicotinic acetylcholine receptor a4b2
- Binding stimulates CNS mesolimbic Dopamine system
- Reinforces nicotine exposure
- Chantix activity
- Chantix Blocks nicotine at a4b2 receptors
- Chantix selectively binds a4b2 receptors
- 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 (consider quitting at 12 weeks)
- Continue for 12 weeks
- Additional 12 weeks may be used if successful
- Higher abstinence rates with delaying quit date to 12 weeks and continuing Chantix for 24 weeks
- Ebbert (2015) JAMA 313(7):687-94 +PMID:25688780 [PubMed]
- Dosing adjustment: Renal Impairment
- Severe renal Impairment: Max dose 0.5 mg PO bid
- End-stage renal disease: Max dose 0.5 mg PO daily
- 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]
-
Drug Interactions
- Alcohol
- Increases risk of Intoxication, hostility, aggressive, Amnesia behavior
- Cost
- Monthly: $440 (in 2020)
- Efficacy
- Cessation for >1 year in 20% (10% with Placebo)
- Cessation rates are as good if not better than Zyban
- Number Needed to Treat (for longterm cessation): 9
- More effective when combined with Nicotine Replacement
- Koegelenberg (2014) JAMA 312(2): 155-61 [PubMed]
- References
- (2020) presc lett 27(9):51-2
- Larzelere (2012) Am Fam Physician 85(6): 591-8 [PubMed]
- Love (2007) Am Fam Physician 76:279-80 [PubMed]
- Oncken (2006) Arch Intern Med 166: 1571-7 [PubMed]
- Tonstad (2006) JAMA 296: 64-71 [PubMed]