Varenicline (Chantix) Starter Pack Prescription for Smoking Cessation
The recommended prescription for Chantix (varenicline) starter pack begins with 0.5 mg once daily for days 1-3, then 0.5 mg twice daily for days 4-7, followed by 1 mg twice daily for the remainder of treatment (typically 12 weeks total). 1
Dosing Schedule
- Days 1-3: 0.5 mg once daily 1
- Days 4-7: 0.5 mg twice daily 1
- Day 8 to end of treatment: 1 mg twice daily 1
Administration Guidelines
- Varenicline should be taken orally after eating and with a full glass of water 1
- Treatment should begin one week before the patient's quit date 1
- Alternatively, the patient can begin varenicline and quit smoking between days 8 and 35 of treatment 1
- Standard treatment duration is 12 weeks 2
- For patients who successfully quit smoking after 12 weeks, an additional 12-week course is recommended to increase the likelihood of long-term abstinence 1, 2
Dosage Adjustments
- For patients with severe renal impairment (creatinine clearance <30 mL/min): Start with 0.5 mg once daily, maximum dose 0.5 mg twice daily 1
- For patients with end-stage renal disease on hemodialysis: Maximum dose 0.5 mg once daily 1
- Temporary or permanent dose reduction may be considered for patients who cannot tolerate side effects 1
- No dosage adjustment is necessary for elderly patients or those with hepatic impairment, though monitoring renal function in elderly patients may be useful 1
Common Side Effects
- Nausea (occurs in 30-40% of users, typically mild to moderate, diminishes over time) 3
- Insomnia (14-15% of users) 3
- Abnormal or vivid dreams (10-13% of users) 3
Monitoring and Precautions
- Monitor for neuropsychiatric symptoms, including depression and suicidal ideation/behavior 3
- Use with caution in patients with a history of seizures or factors that may lower seizure threshold 1
- Contraindicated in patients with a known history of serious hypersensitivity reactions to varenicline 1
- Patients with brain metastases should avoid varenicline due to seizure risk 3
- Nausea may need careful management, especially in patients with cancer undergoing chemotherapy 2
Behavioral Support
- Provide appropriate educational materials and counseling to support the quit attempt 1
- Four or more counseling sessions during the 12-week course of pharmacotherapy are recommended 2
- The first counseling session should occur within the first 2-3 weeks of treatment 2
- Sessions should last 10-30+ minutes, with longer and more frequent sessions linked to higher success rates 2
Follow-up Recommendations
- Follow-up is recommended within 2-3 weeks after starting pharmacotherapy 2
- Additional periodic follow-up during therapy (at minimum 12-week intervals) and after completion 2
- For patients who relapse or fail to achieve abstinence, consider switching to a different pharmacotherapy or intensifying behavioral therapy 2
Despite previous concerns, recent evidence suggests varenicline does not significantly increase neuropsychiatric adverse events compared to nicotine patches or placebo, and the benefits of smoking cessation generally outweigh the risks of side effects 3, 2.