CHANTIX also known as CHAMPIX in the EU and other countries (varenicline) is the latest option for smoking cessation. It's the first PARTIAL nicotine agonist. It binds to nicotine receptors, but stimulates them less than nicotine. This partial nicotine effect helps ease withdrawal symptoms. But having the drug on board also BLOCKS some of the pleasurable effects that patients get if they smoke.
Chantix works at least as well as Zyban (bupropion hydrochloride) to help smokers kick the habit. But long-term success rates are still low. Start Chantix a week BEFORE a patient's quit date and titrate up to effective levels. Prescribe 0.5 mg/day for 3 days, then 0.5 mg BID for 4 days and 1 mg BID for 12 to 24 weeks. The titration is available in a starter pack.
About a third of patients will complain of nausea. Decrease the dose if it's intolerable. Chantix will cost much less than a pack of cigarettes. For now, don't prescribe nicotine replacement with Chantix. The combo causes more nausea and it's not known if it works better. Keep in mind that most smokers need extra support to help them quit, products alone are often not enough. Encourage patients to enroll in a good smoking cessation program.
REFERENCES
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Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, Billing CB, Watsky EJ, Gong J, Williams KE, Reeves KR; Varenicline Phase 3 Study Group. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA. 2006 Jul 5;296(1):47-55. Available at: https://jamanetwork.com/journals/jama/fullarticle/211000
Foulds J. The neurobiological basis for partial agonist treatment of nicotine dependence: varenicline. Int J Clin Pract. 2006 May;60(5):571-6. Available at: https://onlinelibrary.wiley.com/doi/10.1111/j.1368-5031.2006.00955.x