Can I take nicotine (nicotine replacement therapy) patches and Chantix (varenicline) together?

Using Nicotine Patches and Chantix (Varenicline) Together

Yes, you can use nicotine patches and Chantix (varenicline) together, though this combination may increase certain side effects like nausea, headache, and dizziness compared to using either treatment alone.

Evidence for Combination Therapy

The FDA label for varenicline specifically addresses this combination:

• Co-administration of varenicline and nicotine replacement therapy (NRT) has been studied and is pharmacologically possible 1
• However, the combination increases the incidence of adverse effects including nausea, headache, vomiting, dizziness, dyspepsia, and fatigue compared to NRT alone 1
• In clinical studies, 36% of patients using the combination discontinued treatment due to adverse events, compared to only 6% using NRT with placebo 1

Efficacy of Combination Therapy

Recent research provides mixed evidence on whether combining these treatments improves cessation rates:

• A 2021 randomized clinical trial found no significant differences in 7-day point prevalence abstinence at 52 weeks between varenicline plus nicotine patch therapy versus varenicline monotherapy 2
• This study does not support using the combination over monotherapy for improved long-term outcomes 2

Recommended Approach

The National Comprehensive Cancer Network (NCCN) guidelines recommend two preferred primary therapy options for smoking cessation:

1. Combination nicotine replacement therapy (nicotine patch + short-acting NRT) OR
2. Varenicline monotherapy 3

Both options are typically prescribed for a minimum of 12 weeks 3, 4.

Side Effect Management

If using the combination:

• Monitor for increased side effects, particularly nausea (which is common with varenicline and may need management) 3
• Be aware that the combination increases risk of:
  • Nausea
  • Headache
  • Vomiting
  • Dizziness
  • Dyspepsia
  • Fatigue 1

Follow-up Recommendations

• Assessment of smoking status and medication side effects should be performed within 2-3 weeks of starting therapy 3, 4
• Continue periodic monitoring at no more than 12-week intervals 3
• Nicotine withdrawal symptoms typically peak within 1-2 weeks of quitting before subsiding 3

Special Considerations

• Varenicline is contraindicated for patients with brain metastases due to seizure risk 3
• Dosing of varenicline typically follows this schedule:
  • Days 1-3: 0.5 mg once daily
  • Days 4-7: 0.5 mg twice daily
  • Weeks 2-12: 1 mg twice daily (if tolerated) 3

Alternative Approaches

If the combination causes intolerable side effects, consider switching to one of these evidence-based approaches:

1. Varenicline monotherapy (preferred primary therapy) 3
2. Combination NRT (nicotine patch + short-acting NRT like gum, lozenge, inhaler, or nasal spray) 3, 4
3. Bupropion ± NRT (alternative option) 3

While combination therapy is pharmacologically possible, the current evidence suggests that the increased side effects may not be offset by improved cessation rates, making varenicline monotherapy or combination NRT potentially better options for most patients.