Names and pronunciation
(var-e-ni′kleen) Champix , Chantix, Tyrvaya
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Drug reference
(var-e-ni′kleen) Champix , Chantix, Tyrvaya
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Func. class.: Smoking cessation agent
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Chem. class.: Nicotine receptor agonist
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ACTION: Partial agonist for nicotine receptors; partially activates receptors to help curb cravings; occupies receptors to prevent nicotine binding
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USES: Adjunct to psychosocial inter ventions for tobacco cessation (smoking); dry eye disease (Tyrvaya)
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CONTRAINDICATIONS: Hyper sensitivity, eating disorders Precautions: Pregnancy, breastfeeding, children <18 yr, geriatric patients, renal disease, recent MI, angioedema, bipolar disorder, depression, schizophrenia, sui cidal ideation
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SIDE EFFECTS CNS: Headache, agitation, dizziness, insomnia, abnormal dreams, fatigue, mal aise, behavioral changes, depres sion, homicidal ideation, suicidal ideation, amnesia, hallucinations, hostility, mania, psychosis, tremors, seizures, stroke CV: Dysrhythmias, MI EENT: Blurred vision GI: Nausea, vomiting, dry mouth, increased/decreased appetite, constipa tion, flatulence, GERD, diarrhea, gingivi tis, dyspepsia, enterocolitis GU: Erectile dysfunction, urinary fre quency, menstrual irregularities INTEG: Rash, pruritus, angioedema, Stevens-Johnson syndrome, flushing, dermatitis MS: Back pain, myalgia, arthralgia HEMA: Anemia
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DOSAGE AND ROUTES Smoking cessation • Adult: PO therapy should begin 1 wk before smoking stop date, take product plus tobacco for 7 days; titrate for 1 wk; days 1 through 3, 0.5 mg/day; days 4 through 7, 0.5 mg bid; day 8 through end of treatment, 1 mg bid; treatment is for 12 wk and may be repeated for an other 12 wk Dry eye disease Adult: Nasal 1 spray in each nostril q12h Renal dose • Adult: PO CCr ≤50 mL/min, titrate to max 0.5 mg bid
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Available forms: Tabs 0.5, 1 mg; nasal spray 0.03 mg
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Administer: • Do not break, crush, or chew tabs • Increased fluids, bulk in diet if con stipation occurs • After eating with a full glass of water • Sugarless gum, hard candy, frequent sips of water for dry mouth
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Assess: • Smoking history: motivation for smoking cessation, years used, amount each day; smoking cessation after 12 wk; if progress not made, product may be used for additional 12 wk • Renal function in geriatric patients; cardiac status in cardiac disease • Neuropsychiatric symptoms: mood, sensorium, affect; behavioral changes, agitation, depression, suicidal ideation; suicide has occurred; possible worsening of depression, schizophrenia, bipolar dis- order, risk is increased in adolescents • Angioedema, Stevens-Johnson syn- drome: rash during treatment; discontinue if rash, fever, fatigue, joint pain, lesions occur • CV reactions: Stroke, MI more com- mon in those with CV disease • Seizures: May be increased in those with seizure disorders • Risk of hypotension: take B/P base line and periodically • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk, no well- controlled studies
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Evaluate: • Therapeutic response: smoking ces sation
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CLINICAL CONSIDERATIONS V
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Patient and caregiver information: • To set a date to quit smoking and to initiate treatment 1 wk before that date • That treatment for smoking cessation lasts 12 wk and that another 12 wk may be required • To use caution when driving, per forming other activities requiring alert ness; blurred vision may occur • How to titrate product • Not to use with nicotine patches unless directed by prescriber; may increase B/P • That vivid dreams, insomnia may oc cur during beginning of treatment, but usually subside • To notify prescriber of all OTC, pre scription, or herbal products used • To notify prescriber immediately of change in thought/behavior (suicidal ide- ation, hostility, depression); stop product • Not to drive or operate machinery until effects are known • To notify prescriber if pregnancy is planned or suspected or if breastfeeding HIGH ALERT
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PHARMACOKINETICS Elimination half-life 24 hr; metabolism minimal; 93% excreted unchanged in urine; steady state 4 days, onset 4 days, peak 3-4 hr
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• Adult: PO therapy should begin 1 wk before smoking stop date, take product plus tobacco for 7 days; titrate for 1 wk; days 1 through 3, 0.5 mg/day; days 4 through 7, 0.5 mg bid; day 8 through end of treatment, 1 mg bid; treatment is for 12 wk and may be repeated for an other 12 wk Dry eye disease Adult: Nasal 1 spray in each nostril q12h Renal dose
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• Adult: PO CCr ≤50 mL/min, titrate to max 0.5 mg bid
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