Can I add Chantix (varenicline) to a medication regimen that includes Abilify (aripiprazole), Viibryd (vilazodone), and Adderall (dextroamphetamine and amphetamine)?

Can Chantix (Varenicline) Be Added to Abilify, Viibryd, and Adderall?

Yes, Chantix (varenicline) can generally be added to this regimen, but there is significant concern about a potential drug interaction with Adderall that may reduce varenicline's effectiveness for smoking cessation. 1

Critical Drug Interaction Concern

A case report documented that amphetamine-dextroamphetamine (Adderall) may completely negate varenicline's smoking cessation benefits. 1 In this case:

• An 18-year-old successfully quit smoking on varenicline while taking reduced doses of Adderall 1
• When full-dose Adderall (30 mg twice daily) was resumed, the patient relapsed to smoking within 48 hours 1
• Rechallenge with varenicline while continuing Adderall yielded similar failure 1
• The proposed mechanism is that amphetamine addition may eliminate varenicline's partial agonism at nicotinic receptors 1

This interaction suggests varenicline may not effectively aid smoking cessation in patients taking amphetamine medications. 1

Safety Profile When Combined

Neuropsychiatric Safety

• The EAGLES trial (8,144 participants) found no significant increase in neuropsychiatric adverse events with varenicline compared to placebo or nicotine patch 2
• A systematic review of 39 trials (10,761 participants) found no increased risk of suicide, suicidal ideation, depression, or death with varenicline 3
• However, the FDA label and NCCN guidelines recommend monitoring for development or worsening of depression and suicidal ideation/behavior, particularly given your patient is already on psychiatric medications (Abilify and Viibryd). 4, 5

Seizure Risk

• Varenicline carries a seizure risk, particularly during the first month of treatment 5
• This is contraindicated in patients with brain metastases but is not a specific concern with your medication combination unless there are other seizure risk factors 4, 6

Common Side Effects to Monitor

• Nausea (30-40% of users) 6
• Insomnia (14-15%) 6
• Abnormal/vivid dreams (10-13%) 6
• These may be particularly problematic given the patient is already on stimulant medication (Adderall) which can cause insomnia 5

Practical Recommendations

Given the documented interaction with Adderall, consider these alternatives:

1. First option: Use combination nicotine replacement therapy (NRT) instead - nicotine patch plus short-acting NRT (lozenge/gum) for 12 weeks, which is equally recommended as first-line therapy 4

2. Second option: If varenicline is strongly preferred, attempt a trial but:

   • Set realistic expectations about potentially reduced efficacy 1
   • Consider temporarily reducing Adderall dose if clinically feasible 1
   • Provide intensive behavioral therapy support 4
   • Monitor closely for treatment failure within first 2-3 weeks 4

3. Monitor for neuropsychiatric symptoms given the combination with Abilify (aripiprazole, an antipsychotic) and Viibryd (vilazodone, an antidepressant) 4, 5

4. Avoid alcohol during varenicline treatment, as it can cause increased intoxication and unusual/aggressive behavior 5

Dosing If Proceeding with Varenicline

Standard dosing per NCCN guidelines 4:

• 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)
• Initiate 1-2 weeks prior to quit date 4

Follow-up within 2 weeks of starting therapy is essential to assess efficacy and side effects. 4