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What is Chantix, how does it work?
Chantix (varenicline) is a medication used to help smokers quit smoking. It is the only medication in its class and presents an exciting new option in nicotine addicted patients. Chantix (varenicline) is known as a nicotine acetylcholine receptor partial agonist. This simply means that it affects the brain in a similar way as the nicotine in cigarettes, therefore the patient will not feel the craving of cigarettes. It also blocks the effects of nicotine that is inhaled from cigarette smoke. In this way, the patient will not get any rewarding effects from any nicotine if it is smoked while he is taking Chantix (varenicline).
How effective is Chantix in helping me quit smoking?
Smoking is one of the hardest addictions to quit. Further we must keep in mind, that the patient will need continous positive reinforcement.
To look at its effectiveness, we will look at studies of Chantix (varenicline) compared with placebo (ie-sugar pill that contains no active drug). We will look at the outcome success rates (percentage of people who quit successfuly), at 12 weeks, 24 weeks, and 52 weeks.
12 weeks (short term) -- 47.0% versus 13.9% on placebo
24 weeks -- 28.2% versus 9.5% on placebo
52 weeks -- 19.2% versus 7.2% on placebo
Overall, this shows that Chantix (varenicline) is EFFECTIVE in helping a patient quit smoking (almost 3 times greater than placebo) at 1 year from the start of treatment.
Can Chantix be combined with the patch or with Zyban to increase the chances of me quitting?
Combining Chantix (varenicline) and Zyban has never been studied, however it is generally accepted that this combination be avoided due to the potential of additive side effects.
Combining Chantix (varenicline) and the patch (nicotine replacement therapy) has been studied and it is agreed that this combination should be avoided. It is thought that due to the action of Chantix (varenicline), NRT (the patch) will not provide any benefit. Also, it has been shown that the side effects were greatly increased than with Chantix (varenicline) alone, increased nausea, vomiting, headache, stomach upset, and dizziness.
Is Chantix more effective than the patch or Zyban?
Many patients will already have already tried another method to quit smoking. Therefore it is important to know if Chantix (varenicline) will be more effective than other potential therapies.
Again, we will look at studies to see if it is more effective.
Looking at the endpoint, 6 months or longer, abstinence from smoking. An important study evaluated this and came up with the following conclusions.
Zyban vs Chantix -- after 6 months or longer 21% quit rate versus 14% with Zyban.
Zyban vs NRT (nicotine patch) -- after 6 months 19% quit rate with Zyban versus 14% for the patch.
NOTE: this study used fewer patients.
Based on these facts it is concluded that Chantix is significantly more effective than Zyban and the patch, while Zyban is more effective than the patch.
What are the possible side effects of Chantix?
The most common side effect of Chantix (varenicline) will be nausea. This occurs in up to 30% of patients and will vary in intensity from patient to patient. If it is of a moderate to severe nature, the patient will probably be advised to reduce the dosage before attempting to quit taking the medication altogether.
The other common side effects of Chantix (varenicline) include abnormal dreams (up to 13%), insomnia (up to 19%), and less commonly dry mouth and constipation (5-7%).
Who should not take Chantix or who should use Chantix with caution?
While Chantix (varenicline) is an effective medication to assist in helping the patient quit smoking, there exists certain population groups that should not take Chantix (varenicline).
1)Epileptics--not been studied and there is a potential increased risk of seizures.
2)Patients undergoing chemotherapy--it has not been studied.
3)Pregnant or nursing women.
4)Patients with GI disturbances such as Irritable bowel syndrome, it has not been studied and due to the potential GI (stomach) side effects, this combination is not recommended.
5)Patients with a history of depression, schizophrenia, bipolar disorder, or mood instability. There exists a large debate currently on exactly how Chantix (varenicline) will interfere with a mentaly unstable patient, or a patient prone to mental instability. Therefore it is recommended that Chantix (varenicline) be avoided or used with caution in this patient population.
6)Patients with renal (kidney) disease. Should be avoided in patients with moderate or severe kidney disease. This is because kidney disease may lead to increased side-effects of Chantix (varenicline).
Will Chantix interact with my other medications, foods, herbs?
Chantix (varenicline) will not interfere with other medications and is generally considered safe. It also has no known interactions with any foods or herbs.
How do I take Chantix?? Do I quit smoking before I start Chantix?
The patient is generally advised to quit smoking 1-2 weeks after starting Chantix (varenicline). It will usually take about 1 week for Chantix (varenicline) to have the maximum effect in terms of controlling nicotine cravings.
Chantix (varenicline) comes as 2 doses, 0.5mg and 1mg. The patient will initally be stabilized on Chantix (varenicline) 0.5mg for 1 week and then be increased to Chantix (varenicline) 1mg.
The schedule is as follows:
Days 1-3 -- O.5mg once daily
Days 4-7 -- 0.5mg twice daily
Days 8-rest of treatment period -- 1mg twice daily
The duration of treatment will depend on your doctor’s advice, it is recommended at least 6 months of treatment, and up to 1 year. The patient is strongly advised not to be overconfident and discontinue Chantix (varenicline) if they are initially smoke-free. It is generally agreed that the longer a patient takes Chantix (varenicline) the longer he will remain smoke free.
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