Varenicline (Chantix)
Nicotinic acetylcholine receptor partial agonist
- Nicotine cessation (more effective than bupropion)1
- Alcohol use disorder (whether smoking or not)3
Features
Dosing
0.5mg 1 qd x3d ays, 1 bid x3 days, then 2 bid
Management
Varenicline is the most effective med for nicotine, even beating bupropion in depressed patients. Reduces comorbid alcohol use, and in one RCT reduced alcohol use disorder in non-smokers.
TOLERABILITY: nightmares (treat by lowering dose or adding clonidine, which reduces nightmares and nicotine).
Rarely can cause agitation, worse mood. Can use with nicotine but will worsen side effects of nicotine. Most effective med for nicotine. Also helps combined nicotine/alcohol.
EMR Text
Nicotine
Varenicline use based on FDA approval for smoking cessation.
Varenicline side effects reviewed with patient.
Alcohol
Varenicline use based on controlled trials where it improved alcohol use disorder, both in smokers and non-smokers (Söderpalm B et al, Lancet Reg Health Eur. 2025;54:101310).
Varenicline side effects reviewed with patient.