Prescribing Chantix (Varenicline) for Smoking Cessation
The proper procedure for prescribing Chantix (varenicline) requires initiating treatment 1-2 weeks before the patient's quit date, with a gradual titration schedule of 0.5 mg once daily for days 1-3,0.5 mg twice daily for days 4-7, followed by 1 mg twice daily for weeks 2-12. 1, 2
Initial Assessment and Patient Selection
- Evaluate patient's motivation to quit smoking
- Assess for contraindications:
- Pregnancy or women actively trying to conceive
- Severe hypersensitivity reactions to varenicline
- Women who are nursing (not recommended)
- Patients with brain metastases who have history of seizures 1
Dosing Protocol
Standard Dosing Regimen
- Start 1-2 weeks before quit date
- Days 1-3: 0.5 mg once daily
- Days 4-7: 0.5 mg twice daily
- Day 8 to end of treatment: 1 mg twice daily
- Total treatment duration: 12 weeks 3, 1, 2
Special Populations
- Renal Impairment:
- Mild to moderate: No dosage adjustment needed
- Severe (CrCl <30 mL/min): Start with 0.5 mg once daily, maximum 0.5 mg twice daily
- End-stage renal disease on hemodialysis: Maximum 0.5 mg once daily 2
- Elderly: No specific dose adjustment, but monitor renal function 2
- Hepatic Impairment: No dosage adjustment necessary 2
Patient Instructions
- Take after eating with a full glass of water
- Set a specific quit date (typically 1 week after starting medication)
- Alternatively, patient can begin treatment and quit between days 8-35 2
- For patients unable to quit abruptly, consider gradual approach:
- Reduce smoking by 50% within first 4 weeks
- Reduce by additional 50% in next 4 weeks
- Aim for complete abstinence by 12 weeks 2
Follow-Up and Monitoring
- Schedule follow-up within 2-3 weeks after starting pharmacotherapy
- Additional periodic follow-up during therapy (at minimum 12-week intervals)
- Monitor for common side effects:
- Watch for neuropsychiatric symptoms (agitation, depression, suicidal ideation)
- Consider dose reduction for patients who cannot tolerate side effects 3
Behavioral Support
- Combine medication with behavioral therapy for best outcomes
- Recommend 4+ sessions during 12-week course
- First session within first 2-3 weeks
- Session duration: 10-30+ minutes 3
- Provide educational materials to support quit attempt 2
Extended Treatment
- For successful quitters at 12 weeks, consider additional 12 weeks of treatment
- This approach increases likelihood of long-term abstinence 3, 2
- For relapsed patients, encourage another attempt after addressing factors contributing to failure 2
Important Considerations
- Varenicline is more effective than bupropion and single nicotine replacement therapy for smoking cessation 1
- Nausea is the most common side effect and may need management, especially in cancer patients undergoing chemotherapy 3
- The benefits of smoking cessation with varenicline far outweigh potential side effects 1
- Combining varenicline with counseling significantly improves quit rates compared to either approach alone 1
By following this structured approach to prescribing Chantix, you can optimize treatment outcomes and help patients successfully quit smoking.