From the Guidelines
Varenicline should be started 1-2 weeks before the planned quit date for smoking cessation, as this allows the medication to reach steady-state levels and helps reduce nicotine cravings and withdrawal symptoms. The standard regimen begins with a 3-day period of 0.5 mg once daily, followed by 0.5 mg twice daily for days 4-7, then increasing to the maintenance dose of 1 mg twice daily for the remainder of the treatment course (typically 12 weeks total) 1. This approach is supported by the most recent guidelines, which emphasize the importance of combining pharmacotherapy with behavioral support or counseling for optimal results 1.
Key Considerations
- The pre-quit initiation of varenicline helps minimize side effects like nausea, which is the most common adverse effect 1.
- Varenicline works by partially activating nicotine receptors in the brain, which both reduces cravings and blocks the pleasurable effects if you do smoke 1.
- For best results, combine varenicline with behavioral support or counseling, such as telephone-based support, interactive internet-based interventions, or text message–based interventions 1.
- Treatment can be extended for an additional 12 weeks if needed to maintain abstinence 1.
Benefits and Risks
- Varenicline has been shown to be more effective than bupropion or NRT in achieving abstinence from cigarette smoking in meta-analyses of randomized trials 1.
- However, it is essential to weigh the substantial benefits of immediate smoking cessation versus the risks of increased hostility, depression, or suicidal behavior, especially in patients with a history of psychiatric disorders 1.
From the FDA Drug Label
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. Instruct patients to set a date to quit smoking and to initiate varenicline treatment one week before the quit date. Alternatively, the patient can begin varenicline dosing and then set a date to quit smoking between days 8 and 35 of treatment
When to start varenicline:
- 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. 2 2
From the Research
When to Start Varenicline
- Varenicline treatment should begin 7 days before the proposed smoking quit date, with dose titration recommended to minimize dose-related nausea 3.
- The medication is started 1 week before a target quit date, uptitrated to 1 mg twice daily, and continued for 12-24 weeks 4.
Importance of Timing
- The timing of varenicline initiation is crucial, as it allows the medication to reach its full effect by the time the quit date arrives.
- Starting varenicline 7 days before the quit date can help reduce cravings and withdrawal symptoms, making it easier for smokers to quit 3.
Efficacy and Safety
- Varenicline has been shown to be effective in achieving smoking cessation, with studies demonstrating its superiority over other pharmacotherapies, such as bupropion and nicotine replacement therapy 5, 6, 7.
- The medication is generally well-tolerated, with common adverse events including nausea, insomnia, and headache 3, 7.