Chantix (varenicline) for Nicotine Cessation
Dr. Danish frequently works with patients using various medications, including Chantix, to manage nicotine addiction. Chantix is a medication specifically designed to help individuals quit smoking. It functions by blocking nicotine receptors in the brain, reducing the pleasurable effects of smoking and easing withdrawal symptoms. By stabilizing these neurochemical pathways, Chantix provides a valuable tool in the comprehensive treatment plans that Dr. Danish and his team at Philadelphia Integrative Psychiatry develop for their patients. This holistic approach, which combines medication management with therapy, lifestyle adjustments, and other supportive measures, aims to address the multifaceted nature of nicotine addiction.
Efficacy of Chantix
Chantix (varenicline) is widely recognized as the most effective single product for smoking cessation. Studies have shown that it is superior to bupropion and has equal efficacy to nicotine replacement therapy. In a 52-week double-blind placebo-controlled study, subjects treated with Chantix had significantly higher continuous abstinence rates compared to placebo at weeks 15 through 24 (32% vs. 7%) and weeks 15 through 52 (24% vs. 6%). This makes Chantix a powerful option for those looking to quit smoking.
Dosing and Administration
Chantix is typically started one week before the planned quit date. The dosing regimen begins with a lower dose that gradually increases:
Days 1 to 3: 0.5 mg once daily
Days 4 to 7: 0.5 mg twice daily
Day 8 to end of treatment: 1 mg twice daily
Patients are advised to take Chantix with food and a full glass of water to minimize nausea. The treatment duration is usually 12 weeks, but some patients may benefit from an additional 12 weeks to maintain abstinence.
Potential Side Effects
Common side effects of Chantix include nausea, sleep disturbances, and vivid dreams. These symptoms are generally mild and can often be managed by adjusting the dose or taking the medication with food.
Mental Health Concerns
Initial concerns about Chantix included potential mental health side effects such as depression and suicidal thoughts. However, more recent and larger studies have shown no significant difference in these side effects compared to placebo. It is important to monitor any changes in mood or behavior and discuss them with a healthcare provider.
Cancer Risk and Market Withdrawal
In July 2021, Pfizer recalled Chantix due to elevated levels of N-nitroso-varenicline, a nitrosamine impurity linked to increased cancer risk. To address the resulting shortage, the FDA temporarily allowed the distribution of generic varenicline with higher nitrosamine levels, up to 185 nanograms per day, while working with manufacturers to reduce these levels. The FDA is now confident that the generic versions of varenicline currently available in the U.S. market have been manufactured to contain N-nitroso-varenicline levels at or below the FDA's acceptable intake limit of 37 nanograms per day, which they deem safe.
Nicotine Use and Health Risks
While adding medications is always a risk:reward scenario, nicotine use is terrible for the body and mind. Chronic nicotine use can lead to significant health issues, including:
Cardiovascular Problems: Increased risk of high blood pressure and changes in heart rhythm.
Respiratory Issues: Shortness of breath and bronchospasms.
Central Nervous System Effects: Cognitive impairments, emotional disturbances, and increased risk of depression, particularly when exposure begins during adolescence.
Metabolic Changes: Increased risk of metabolic syndrome and diabetes.
FDA-Approved Medications for Nicotine Dependence
As of July 2024, the three FDA-approved medications for treating nicotine dependence are:
Nicotine patches
Bupropion (Wellbutrin)
Varenicline (Chantix)
Mechanism of Varenicline
Varenicline is a “partial agonist” at nicotinic receptors. This means it can block nicotine from cigarettes from activating the receptors but also activates the receptors itself. The nicotine receptors most important in addiction interact with the structure of the brain called the nucleus accumbens via the mesolimbic dopamine tracks.
Starting Varenicline
Varenicline should be started 7 days prior to the quit date, aiming for a quit date on day 8. Some patients may quit as late as 5 weeks or taper down use over 3 months. Even without a set quit date, varenicline can be helpful because it decreases cravings.
Duration of Use
Varenicline should be continued for 11 weeks or more until cravings subside, then stopped without tapering. Some patients continue for as long as 1 year.
Combination with Nicotine Patches
It is safe to use varenicline along with nicotine patches. If someone is having trouble quitting with just varenicline, it’s okay to add nicotine patches.
Main Side Effects
Nausea: 15% of patients; tends to lessen over time.
Insomnia: 33% of patients; tends to lessen over time.
Nightmares: Rare, but can be helped by clonidine if they do occur.
Headaches and Dizziness: Rare side effects.
Addressing Initial Black Box Warning
The initial black box warning that Chantix can lead to worsening depression or suicidal thinking was later proven to be false. A large meta-analysis found no association between varenicline and depression or suicidality.
Additional Tips for Quitting Nicotine
Get cigarettes (or vapes, chewing tobacco, cigars, etc.) out of the house.
Change the normal smoking areas around—if you have a favorite area on the porch or a favorite smoking chair, move that to another location.
Clean your ashtray right after smoking.
Contact 1-800-QUIT-NOW, a nationwide free resource to help quit using nicotine.
Getting in Touch with Dr. Danish and his Team
At Philadelphia Integrative Psychiatry, we take pride in our ability to practice the most subtle nuances of psychiatry, which is an inherently subjective field full of misdiagnoses and lazy and inaccurate assessment techniques. We want to provide the level of care we would want for our own family members. Our holistic and integrative approach ensures that we consider all aspects of our patients' well-being in developing personalized treatment plans. If you or a loved one are seeking support for nicotine cessation or similar conditions, please text or call 610-999-6414 to learn how we can help.
For more on this topic and related subjects, check out these blogs:
Learn about the benefits of Naltrexone and Vivitrol in treating alcohol use disorder.
Acamprosate is a usually well tolerated and viable treatment option to help cut down on alcohol use.
Discover how Disulfiram (Antabuse) can help stop drinking alcohol.
Find a variety of local and national outpatient and inpatient drug and alcohol treatment options tailored to individual needs.
Disclaimer: Dr. Danish creates these handouts based on research, but they are not meant to be 100% comprehensive. Patients are invited to discuss the ideas brought up in the document with their provider. For full lists of side effects on medications and supplements, visit drugs.com and webmd.com as these lists are always expanding with more research occurring.
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