Varenicline: The Newest Agent for Smoking Cessation

Lisa A. Potts; Candice L. Garwood

Disclosures

Am J Health Syst Pharm. 2007;64(13):1381-1384. 

In This Article

Dosage and Administration

Varenicline was approved for smoking-cessation treatment on May 11, 2006, under the trade name Chantix (Pfizer). A cost comparison of currently available smoking-cessation therapies appears in Table 1 . Varenicline is available in 0.5- and 1-mg tablets. The labeling information recommends adjusting the dosage from 0.5 mg once daily for days 1-3 to 0.5 mg twice daily for days 4-7, with a final dosage of 1 mg twice daily. Varenicline should be initiated one week before the patient's set "quit date." Varenicline is indicated for 12 weeks of treatment, and patients who have stopped smoking by the end of that time should receive an additional 12 weeks of therapy. As the half-life of varenicline is long (approximately 24 hours), steady state is reached only after at least four days of therapy.[10] This would make varenicline a less-than-ideal therapy for patients who must abstain from smoking quickly, as is the case for many hospitalized patients.

The data for varenicline look promising. The marginal benefit that varenicline has demonstrated over bupropion and its unsubstantiated benefit after discontinuation could limit its use. Yet, varenicline may be an option for those patients who concurrently smoke with cessation therapy, since varenicline is a non-nicotine drug and will antagonize the effects of nicotine. However, smoking during varenicline use does increase nausea. It is also important to consider the patient's motivation to quit and utilize behavioral therapies. Varenicline may be useful therapy in the patient who does not tolerate or wishes to avoid the adverse effects of bupropion or who has contraindications to such therapy (e.g., seizures).

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