What is the recommended dosing regimen for Chantix (varenicline)?

Varenicline (Chantix) Dosing Regimen

The recommended dosing regimen for Chantix (varenicline) is to start with 0.5 mg once daily for days 1-3, increase to 0.5 mg twice daily for days 4-7, then 1 mg twice daily for weeks 2-12. 1, 2

Standard Dosing Schedule

• Initial titration (begin 1 week before quit date) 1, 2:

  • Days 1-3: 0.5 mg once daily
  • Days 4-7: 0.5 mg twice daily
  • Week 2-12: 1 mg twice daily (if tolerated)

• Treatment duration: Standard treatment is 12 weeks 1, 2

  • May be extended to promote continued cessation (6 months-1 year) 1
  • For patients who successfully quit after 12 weeks, an additional 12-week course is recommended to further increase likelihood of long-term abstinence 2

• Administration: Take after eating and with a full glass of water 2

Dosing in Special Populations

• Renal impairment 2:

  • 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

• Elderly patients: No specific dosage adjustment, but monitor renal function 2

• Hepatic impairment: No dosage adjustment necessary 2

Alternative Dosing Approaches

• Gradual approach to quitting 2:

  • Begin varenicline dosing and reduce smoking by 50% within first four weeks
  • Reduce by additional 50% in next four weeks
  • Aim for complete abstinence by 12 weeks
  • Continue treatment for additional 12 weeks (total 24 weeks)

• Dose adjustments: Consider temporary or permanent dose reduction in patients who cannot tolerate adverse effects 1, 2

Follow-up Recommendations

• Schedule follow-up within 2-3 weeks after starting pharmacotherapy 1
• Additional follow-up during therapy at minimum 12-week intervals 1
• Follow-up after completion of therapy 1

Common Side Effects and Precautions

• Most common side effect: Nausea (may need management, especially in cancer patients) 1, 3
• Neuropsychiatric effects: Monitor for depression and suicidal ideation/behavior 1
• Contraindications: Brain metastases (seizure risk), history of serious hypersensitivity reactions 1, 2

Clinical Efficacy

• Varenicline is one of the preferred primary therapies for smoking cessation 1
• Increases chances of successful long-term smoking cessation 2-3 fold compared to unassisted attempts 4
• More effective than bupropion SR and nicotine replacement therapy in clinical trials 4, 3