Varenicline

Varenicline is a prescription-only medication used to help you quit smoking. It works by targeting parts of the brain affected by nicotine, reducing:

• cravings
• smoking withdrawal symptoms
• the rewarding effects that make nicotine addictive

The active ingredient in this medication is varenicline. It was previously available under the brand name Champix, but this brand is no longer available in the UK.

Varenicline works by reducing the cravings and the severity of the withdrawal symptoms you might experience when you quit smoking.

Varenicline reduces cravings for nicotine by binding to the same receptors in the brain that nicotine does. By binding to these receptors, varenicline prevents nicotine binding to them and stimulates the release of a small amount of dopamine, the same chemical that reinforces and rewards smoking.

How long does varenicline take to work?

Varenicline starts working within 1 to 2 weeks after starting treatment, and you may notice that you start to crave cigarettes less than you did. Even if you don’t feel any effects within the first two weeks, you should continue with your treatment, as it can take a little longer to start working for some people.

How effective is varenicline?

Clinical trials have compared the effects of varenicline with another smoking cessation medication, bupropion. The results found that after 4 weeks 44.4% of people using varenicline had stopped smoking compared to 29.5% for bupropion and 17.7% for placebo.

Further research assessed the benefit of a further 12 weeks treatment with varenicline to continue helping people stop smoking. The results found that:

• 70% of people were still not smoking between weeks 13 and 24 compared to 49.8% given a placebo
• 44% had still quit smoking between weeks 13 and 52 compared to 37.1% using a placebo

Another study shows that varenicline can help 45.5% of people quit smoking compared to 38.2% for bupropion, 33% for nicotine replacement therapy (NRT), and 4.2% for psychosocial support.

All of these trials show that varenicline has higher success rates compared to other smoking cessation medications.

Varenicline treatment should be started while you are still smoking, but you should aim to stop smoking 7 to 14 days after starting varenicline. You’ll take it for 12 weeks and may be prescribed another 12 weeks if you need further help to continue quitting smoking.

Before you start taking varenicline, decide on the day during the second week of treatment that you are going to stop smoking. Once decided:

1. Take one 0.5mg tablet each day on days 1 to 3.
2. Then, take one 0.5mg tablet twice a day from days 4 to 7.
3. After your first week of treatment, take 1mg twice a day for the remaining 11 weeks. If you experience any side effects that you find difficult to manage, your doctor may lower your dose to 0.5mg twice a day.
4. During your second week, stop smoking on your decided day and continue with your treatment.

Each varenicline tablet should be swallowed whole with a glass of water and can be taken with or without food. From day 4 onwards, you should take varenicline once in the morning and then once in the evening, according to your current dose.

Varenicline dosage

The usual varenicline dosage is:

• Days 1 to 3 – 500mcg (0.5mg) once per day
• Days 4 to 7 – 500mcg (0.5mg) twice per day
• Day 8 onwards – 1mg twice a day

If you cannot tolerate the higher dose of varenicline (1mg twice a day), then your doctor may lower the dose to 500mcg twice a day. You must not lower the dose yourself without speaking to your doctor first.

How long do I need to take varenicline for?

You usually need to take varenicline for 12 weeks, but this may be extended if you do not quit smoking in this time. Your doctor may recommend an additional 12 weeks of treatment consisting of 1mg twice daily of varenicline to help you continue quitting.

Varenicline can be requested from ZAVA or other regulated and trusted online doctor services. You’ll need a prescription from a doctor to obtain it because it is not available over the counter. Varenicline may also be available on the NHS, after an appointment with your GP.

Can I buy varenicline online?

Yes, you can buy varenicline online. Varenicline is a prescription-only medication, so you will need a prescription from a licensed healthcare professional before you can buy it. You should only request varenicline online from trusted online doctor services like ZAVA. We are monitored and regulated to ensure you receive safe and genuine medication.

Getting varenicline from ZAVA is quick and convenient. There’s no need for a face-to-face appointment:

• Complete a short online medical questionnaire – Share details about your health so our doctors can ensure varenicline is right for you.
• Order and pay online – Sign in or create your ZAVA account, select varenicline, and securely make your payment.
• Doctor review and approval – A UK-licensed doctor will check your health information and approve your prescription request if varenicline is safe and appropriate for you.
• Fast and discreet delivery – If approved, varenicline will be delivered discreetly to your home or a local post office for collection.

Can I buy varenicline over the counter?

No, varenicline is not available over the counter. Varenicline is a prescription-only medication so it cannot be bought unless you have a consultation with a doctor or a stop smoking clinician first.

Can I get varenicline on the NHS?

You may be able to get varenicline on the NHS. You will need to make an appointment with your doctor so they can determine if it is suitable for you to take.

Like all medications, varenicline can cause side effects, however, not everyone will experience them.

Very common side effects (may affect more than 1 in 10 people):

• feeling sick (nausea)
• inflammation of the nose and throat
• problems sleeping
• headache
• abnormal dreams

Common side effects (may affect up to 1 in 10 people):

• inflammation of the sinuses
• chest infection
• dizziness
• sleepiness
• heartburn
• being sick (vomiting)
• shortness of breath
• skin rash
• joint aches
• cough
• changes to taste
• muscle aches
• chest pain
• tiredness
• increased weight
• weight loss or gain
• diarrhoea
• feeling bloated
• abdominal pain
• toothache
• constipation
• indigestion
• dry mouth
• flatulence

Uncommon side effects (may affect up to 1 in 100 people):

• viral or fungal infections
• seizures
• tremor
• feeling sluggish
• less sensitive to touch
• ringing in the ears, feeling panic, difficulty in thinking, mood swings, depression
• anxiety, hallucinations, changes to sex drive
• conjunctivitis, eye pain, increase in blood pressure, hot flushes
• blood in stools, irritated stomach, belching, mouth ulcers, pain in the gums
• changes to bowel habits, abnormally frequent urination, urinating at night
• muscle spasms, pain in the chest wall
• increase in the menstrual flow
• discomfort in the chest, flu-like symptoms, fever, feeling weak or unwell
• heart attack, high blood sugar, suicidal thoughts
• changes to thinking and behaviour like becoming agitated or feelings of aggression
• angina, rapid heartbeat, palpitations, increase in heart rate
• inflammation in the nose, throat, or sinuses
• congestion in the nose, throat, or chest, or hoarseness
• hay fever, excess mucus from the nose, runny nose

Rare side effects (may affect up to 1 in 1000 people):

• feeling unwell or unhappy, slow thinking
• excess thirst
• stroke
• disturbed vision, discolouration of the eyeball, dilated pupils, shortsightedness
• sensitive to light, watery eyes
• increase in muscle tension, difficulty with coordination, altered sleeping patterns
• difficulty with speech
• irregular heartbeat or heart rhythm
• snoring, throat pain
• stiff joints, pain in the ribs, blood in vomit, abnormal stools, coating on the tongue
• glucose in the urine, increase to the volume and frequency of urine
• vaginal discharge, changes in sexual ability
• feeling cold, developing cysts
• diabetes
• sleepwalking
• loss of contact with reality, unable to think clearly or make judgements
• abnormal behaviour
• severe skin rashes
• serious allergic reaction

How long do varenicline side effects last?

Most side effects from varenicline are reported to be mild and are resolved within the first few weeks of treatment.

What to do if you get varenicline side effects

Giving up smoking in general can cause various symptoms and side effects whether you use smoking cessation aids or not. For example, some people experience:

• mood changes
• sleep issues
• difficulty concentrating
• decreased heart rate
• increased appetite or weight gain

If you experience any side effects while taking varenicline and are concerned or find them difficult to manage, you should talk to your doctor immediately.

You can also report any side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard.

If you experience any of the following serious side effects, stop taking varenicline and call 999 or get someone to take you to A&E:

• seizure
• stroke
• heart attack
• suicidal thoughts
• changes in judgement, thinking, or behaviour (psychosis)

Varenicline may not be suitable for everyone and it is important to tell your doctor about any existing health conditions or medications you are taking.

Some people who have taken varenicline have reported experiencing depression, suicidal thoughts and behaviour, and suicide attempts. If you are using varenicline and begin to feel agitated, depressed, or have any changes in behaviour, you should stop taking it immediately and contact your doctor straight away.

The effects of stopping smoking

The effects of stopping smoking on the body, with the aid of treatment or not, may mean different people will need different adjustments to their dose.

Stopping smoking with or without treatment can also bring about feelings of anxiety and depression. If you have ever suffered from any psychiatric disorder you should consult your doctor first before starting varenicline.

Before taking varenicline, tell your doctor if you have ever experienced:

• heart or circulatory problems
• seizures
• hypersensitivity reactions
• skin reactions

Varenicline and other medicines

Before taking varenicline, you must let your doctor know if you are taking any prescribed, over-the-counter, or herbal remedies. You should also speak to your doctor before using any other smoking cessation therapies in combination with varenicline.

When you give up smoking, with or without varenicline, you may need your existing medication dose to be adjusted, particularly:

• theophylline
• warfarin
• insulin

If you have severe kidney disease, you should avoid taking cimetidine (used for treating reflux/heartburn/stomach ulcers) at the same time as varenicline.

Varenicline and alcohol

Some people have reported increased intoxicating effects of alcohol when taking varenicline, although there is no conclusive evidence that varenicline increases alcohol intoxication.

Varenicline and pregnancy and breastfeeding

Varenicline is not recommended during pregnancy and you should speak to your doctor about quitting smoking before taking varenicline if you are currently or considering getting pregnant.

Varenicline may pass into breast milk, so you should speak to your doctor before taking varenicline if you are currently breastfeeding.

Varenicline and driving or operating machinery

Varenicline can cause dizziness, sleepiness, or loss of consciousness, so you should not drive or operate machinery until you know if it affects your ability to safely perform these activities.

There are several other quit smoking alternatives available including medication and nicotine replacement therapy.

Quit smoking tablets

Quit smoking tablets can help you overcome cravings and withdrawal symptoms when you are giving up. There are some alternatives to varenicline available. At Zava we offer cytisine and Zyban.

Varenicline Vs Champix

Champix is the branded version of varenicline. This means that both medications contain the same active ingredients, in the same doses, and work in exactly the same way. Champix is no longer available in the UK.

Cytisine vs Varenicline

Cytisine mimics the effects of nicotine by attaching to the same receptors in your brain, making your brain think you’ve had a cigarette and reducing the urge to smoke. Its active ingredient is cytisine and is more than twice as effective as a placebo to help people quit smoking.

Varenicline Vs Zyban

Zyban contains the active ingredient bupropion and was originally used to treat depression, but has also been found to help people quit smoking. Although it’s not known how it exactly works to help you quit smoking, Zyban reduces the nicotine withdrawal symptoms you might experience when you quit smoking.

Other stop smoking services

Aside from medication, there are other services that you can try to help you give up cigarettes, such as:

1. One-to-one and group smoking cessation sessions can provide specialist support on your quit smoking journey.
2. Nicotine replacement therapy (NRT) can help you quit by reducing nicotine cravings and withdrawal symptoms. This includes patches, gum, lozenges, inhalators, and nasal sprays.
3. E-cigarettes and vapes can help you quit tobacco smoking by replacing the nicotine from cigarettes but it’s still not known the full effects of using them long-term.