What is the proper use of Champix (Varenicline) for smoking cessation?

From the Guidelines

Varenicline (Champix) should be used for a 12-week course, with an option to continue for an additional 12 weeks to improve long-term abstinence rates, as part of a comprehensive smoking cessation program that includes behavioral counseling and support.

Proper Use of Varenicline

• The initial dosing of varenicline is 0.5 mg orally, once daily for days 1-3, then 0.5 mg orally, twice daily for days 4-7, and finally 1 mg orally, twice daily for weeks 2-12, if tolerated 1.
• Varenicline is a first-in-class nicotine acetylcholine receptor partial agonist, designed to provide some nicotine effects and to block the effects of nicotine from cigarettes, discouraging smoking 1.
• Common adverse effects of varenicline include nausea, insomnia, abnormal dreams, headache, and fatigue, but most are mild and transient 1.
• Serious neuropsychiatric issues, such as depression and suicidal ideation, are rare but require monitoring and discontinuation of varenicline if they occur 1.

Clinical Recommendations

• Combining pharmacologic therapy, such as varenicline, with behavioral counseling and support is the most effective approach for smoking cessation 1.
• High-intensity behavior therapy with multiple counseling sessions is most effective, but at least a minimum of brief counseling is highly recommended 1.
• Smoking status should be documented in the patient health record, and patient health records should be updated at regular intervals to indicate changes in smoking status, quit attempts made, and interventions utilized 1.

From the FDA Drug Label

Varenicline is a nicotinic receptor partial agonist indicated for use as an aid to smoking cessation treatment. Begin varenicline tablets dosing one week before the date set by the patient to stop smoking. Alternatively, the patient can begin varenicline tablets dosing and then quit smoking between days 8 and 35 of treatment. Starting Week: 0.5 mg once daily on days 1 to 3 and 0.5 mg twice daily on days 4 to 7. Continuing Weeks: 1 mg twice daily for a total of 12 weeks. An additional 12 weeks of treatment is recommended for successful quitters to increase likelihood of long-term abstinence.

The proper use of Champix (Varenicline) for smoking cessation is to:

• Start dosing one week before the quit date or begin dosing and quit between days 8 and 35 of treatment
• Initial dose: 0.5 mg once daily on days 1 to 3, then 0.5 mg twice daily on days 4 to 7
• Continuing dose: 1 mg twice daily for 12 weeks
• Optional extension: an additional 12 weeks of treatment for successful quitters to increase the likelihood of long-term abstinence 2

From the Research

Proper Use of Champix (Varenicline) for Smoking Cessation

The proper use of Champix (Varenicline) for smoking cessation involves a treatment period of 12 weeks, with a recommended dosage of 1 mg twice daily 3, 4, 5.

• The treatment should begin 7 days before the proposed smoking quit date, with dose titration to minimize dose-related nausea 4.
• Varenicline has been shown to be effective in reducing cravings and withdrawal symptoms, and in increasing smoking abstinence rates 3, 4, 5, 6.
• The most common adverse events associated with varenicline are nausea, insomnia, and headache, which are generally mild to moderate and diminish over time 3, 4.

Dosage and Administration

• The recommended dosage of varenicline is 1 mg twice daily, with a treatment period of 12 weeks 3, 4, 5.
• A reduced dosage regimen of 1 mg daily may also be effective in increasing cessation rates 3.
• Varenicline should be taken orally, with or without food, and with a full glass of water 4.

Efficacy and Safety

• Varenicline has been shown to be effective in increasing smoking abstinence rates, with a relative risk of 2.38 compared to placebo 3.
• Varenicline has also been shown to be effective in reducing cravings and withdrawal symptoms, and in increasing smoking abstinence rates in patients who are not ready to quit immediately but are willing to reduce cigarette consumption 6.
• The safety of varenicline has been evaluated in several clinical trials, with the most common adverse events being nausea, insomnia, and headache 3, 4.
• There have been reports of neuropsychiatric events, including changes in behavior, agitation, depressed mood, suicidal ideation, and suicidal behavior, although the relationship between these events and varenicline is not fully understood 3, 4.