The ins and outs of prescribing Chantix (varenicline): an illustrated How-To guide
Chantix is pretty popular these days, and with good reason. It works pretty well. In fact, of all of the people I’ve talked to, there’s not one that’s not had success with it. Anecdotal, but nifty. I was dead wrong in my guess that insurers would balk at paying for it. Even medicaid is paying for it in my area, which is truly mind-blowing given how tight they are with their formulary. Even when it’s not covered, it’s still usually cheaper than buying a month’s worth of cigarettes.
What’s not so nifty about Chantix are the horrific prescriptions we see for it. Directions that make no sense. Or make sense within a certain context, but probably not the context the prescriber was thinking of. This will become clear shortly.
This is a short post, but it’s big because of all of the pictures.
Table of Contents:
- How does Chantix come?
- Normal Chantix Use: prescribing a course of Chantix
- Normal Chantix Use: the first month (photos begin)
- Normal Chantix Use: Month 2 and beyond
- Abnormal Chantix Use and common missteps
How does Chantix come? (Back to top)
Chantix comes in four different packages, only three of which are of any consequence. The Starting Month Pak, the Continuing Month Pak, and bottles of 0.5mg tablets, which are only used when a patient cannot tolerate the side effects of the normal 1mg strength. The fourth package is a bottle of 56 tablets of the 1mg strength, which is exactly the same as the Continuing Month Pak, minus the fancy packaging. We don’t use these.
You can think of Chantix almost like a Medrol Dose Pack: designed for ease-of-use, contained in packaging which explains itself to the patient in very simple terms, with pictures.
Normal Chantix Use: prescribing a course of Chantix (Back to top)
Chantix should ideally be prescribed for most people using two prescriptions:
Chantix starter pack
Sig: Take as directed
#1 package
0 refills
and
Chantix continuing pack
Sig: Take as directed
#X packages
_ refills
The continuing month pack prescription will be used after the patient has finished the starter pack. I have been counseling patients that when the time comes for a refill of their Chantix at the end of the first month to speak with the pharmacy staff to avoid the automated script refill request idiocy that I explained in Footnote #1 of this post.
Normal Chantix Use: the first month (Back to top)
The Starter Pack looks this:
Inside this main pack you’ll find the following mini-packs:
The special pack there is the first week. The blue ones are what’re inside the Continuing Month Pak, and they are all 1mg tablets (Photo). Inside that yellow first week pack you’ll find the following blister tab of 0.5mg tablets:
The end of Week 1 is when the patient is supposed to stop smoking.
Normal Chantix Use: Month 2 and beyond (Back to top)
For the following months, that second prescription with X number of refills is used; inside are four blue packs, as I said before:
Abnormal Chantix Use and common missteps (Back to top)
50% of the time I see a prescription for Chantix, it’s not done correctly. It’ll be written for a Chantix Starter Pack with a bunch of refills, or a hand-written taper schedule that doesn’t make any sense, some variation of these two problems. We smooth this out, but it is imperfect, and each pharmacist does it differently.
Every once in a while, we will come across an instance where a patient was prescribed a Starter Pack, and the followup prescription is for Chantix 0.5mg, 1 tablet twice daily, which makes no sense, given that 3 of the 4 packs in the Starter Pak are for 1mg tablets. Unfortunately, we cannot simply change the prescription to the Continuing Month Pack, even though when we call the prescriber’s office 90% of the time we hear something like “Oh yeah, we meant the continuing month thing.”
“Thing.”
Not especially comforting. I’ve explained to more than one nurse exactly how Chantix comes, and how it’s normally used. In some cases, this information is even relayed back to the prescriber, because I see prescriptions written correctly for someone else later on. It’s a nice feeling.
But that 10% is the killer, which is why we have to call. GI upset is the most common side effect of varenicline, and often by reducing the dose to 0.5mg, these side effects are ameliorated, while retaining the efficacy of the drug. That’s where that niche bottle of 0.5mg tablets is used. Ever so rarely.
In this RARE case, if you a prescriber, and you actually WANT the 0.5mg, and you are AWARE that this is the “wrong” way to use Chantix, write a brief note acknowledging that you know, and would like the 0.5mg tablets anyway. This will go a long way towards ensuring that your prescription will be filled the same everywhere, exactly the way YOU want it.
Not to mention it will save everybody time. Filling prescriptions is not a passive activity.
Technorati Tags: Chantix, pharmacy, medicine, varenicline, smoking, smoking cessation
Related Posts:- FDA approves Chantix for smoking cessation
- What does “2 qd” actually mean?
- An anti-smoking vaccine?
- It seems Eli Lilly and Amylin have a problem with Byetta
- Dextromethorphan and a productive cough
32 Comments »
RSS feed for comments on this post.
| TrackBack URI
You can also bookmark
this on del.icio.us or check the cosmos
Your stories give a very interesting insight to the world of pharmacy.
Comment by RawCode — June 19, 2007 @ 5:25 am
I happen to be aware of the correct way to write for the drug (I looked it up; what a concept!) but the pictures were handy. Thanks.
Comment by #1 Dinosaur — June 19, 2007 @ 6:16 am
Of course YOU did.
Comment by RJS — June 19, 2007 @ 8:38 am
Thankfully, I’ve only seen one prescription for chantix go through the insurance. Most other patients balk at paying $120 (or more) a month just to stop smoking. I even had one patient tell me, “It’s cheaper to smoke two packs a day!” I didn’t even bother responding to that.
Comment by Andrew — June 19, 2007 @ 8:39 am
Interesting. Most of the major insurances in my area cover it now, as I said in the entry. It’s cheaper to prevent cancer than it is to treat it. Particularly for an insurer.
There are a couple of different ways to handle that person.
1) Say nothing. I think I probably would have done the same, or perhaps made a snarky reply, because I do that sometimes.
2) Point out that they won’t be taking Chantix for the next ten years. Ask them if they could pay $1000 in ten monthly installments to stop smoking for the rest of their life, would they?
3) Point out that cancer/COPD/heart disease/etc are not fun diseases.
Comment by RJS — June 19, 2007 @ 8:47 am
How to prescribe Chantix correctly…
OnThePharm with an illustrated primer….
Trackback by Trusted.MD Network — June 19, 2007 @ 11:02 am
I recently tried to fill a Chantix prescription (one sinlge prescription) that the doc had been kind enough to write extreeeemely clearly and printed very nicely. It contained 1 order for the first month and 2 of the continuing month packs. In fact, he copied the format directly from the Chantix Web site.
Rite-Aid refused to fill it, stating they couldn’t supply me the second part of the prescription as it was “a different dose” (notwithstanding that the starter pack contains different doses). They did not offer to call my doc, merely told me flat out they would not fill the scrip as ordered and to request a new scrip from my doc.
So in this case, the doc did exactly what the product Web site said to, and the scrip still got refused.
I won’t go into how they reached over the counter and hit the “No, I do not need advice from the pharmacist” button before I could ask any questions during checkout…
Comment by Jaz-Michael King — June 19, 2007 @ 11:27 am
I’m sorry you had a bad experience. Sounds like you have a situation with an overly-zealous technician running the pharmacy instead of the pharmacist.
In your particular case, I would make a photocopy of the prescription, circle the fact that it was a Continuing Month Pak, and then place it on your file for the additional refills.
You might be better off if you had spoken to the pharmacist, because that is some extremely bad behavior, and had I been in your shoes, the technician would feel about 3″ tall by the time I finished with him/her. I ABHOR bad behavior in the pharmacy.
Comment by RJS — June 19, 2007 @ 11:55 am
Thank you for such a great post about Chantix, complete with pictures. Luckily, my insurance (Kaiser) covered it if I went through their stop smoking program, and my doc even prescribed the first batch correctly.
Comment by Maggie — June 19, 2007 @ 3:49 pm
Well you have now met a failure. I tried chantix and the first week went good. I stopped smoking on day 4 instead of waiting until the entire week was up. Once I started 2 daily of the 1 mg, I was non-stop sick to my stomach. I did ok on the 0.5mg twice daily. My doc did not mention this to me as an option. I dont think he realized it was. he thought the only thing available was starter pk and continuing month pkgs.
I gave up and started smoking again. I lasted a little more than 3 weeks total.
you should have informed that pt. who thinks they can smoke 2 pkg daily for less money… that they need a course in simple matematics. With cigs being almost 4.00 per pk (some places more) that comes out to almost 240.00 per month/2 pkg daily.
I had high hopes for chantix but being ill all the time was not an option. Now i’m going for the patches and gum.
Comment by mjl — June 19, 2007 @ 8:46 pm
Chantix is like my new philanthropy. I’ll tell anyone that will listen about how awesome this stuff is. I used to LOVE to smoke. But now I REALLY love not smoking. I’m on my 6th week without the smokes and I cannot believe how easy it’s been.
Doc and I were talking about it over dinner tonight and remarking how Nicorette did such a good job with their marketing, I’m surprised Pfizer hasn’t done more to get Chantix noticed in the media.
RJS, any particular reason why your pharmacy doesn’t do the bottle of 1mg tablets?
Comment by ms_lady_jaye — June 19, 2007 @ 11:44 pm
Because they’re identical to the Contuining Month Pak. Both have 56 tablets. The Continuing Month Pak is preferred by most people, so it’s what we use. Keeping a bottle of the 1mg tablets around increases our inventory unnecessarily.
Comment by RJS — June 20, 2007 @ 8:49 am
what happens when you get an rx that says chantix 1 mg #60 or #90 i have seen both.
Comment by dan — June 24, 2007 @ 7:24 pm
I would give the Continuing Month Pak, and try to give multiple months if the insurance allows it. If they don’t, then use the Contuining Month Pak with the proper number of refills.
Treat it like birth control, basically.
Comment by RJS — June 24, 2007 @ 7:27 pm
I’ve read a lot of posts about Chantix on the web, and, I must say, this one is very well done.
I am another person who is in the Chantix success category. I stopped after two months of the tablets, and, I am still doing fine.
I paid for the Chantix out of pocket. Perhaps the single best thing I’ve ever purchased. : )
John Smith
Comment by John Smith — July 25, 2007 @ 10:05 pm
I took Chantix for 15 days….stopped smoking on the 5th day. I haven’t had a cigarette since August 6…..After my first week, I was nauseus and uncomfortable but did not want to smoke. The hardest part wasn’t giving up nicotine, the addiction; but giving up the habit. My insurance paid half of the prescription ($60.00)….I have saved several hundred dollars…..
I did not believe I could ever quit smoking…I’m sold on Chantix
Comment by Shirley Newell — September 25, 2007 @ 6:42 pm
My doctor prescribed me the starter pak of Cantix with monthly refills X4, I believe. The problem: My co-pay amounts to a hefty $100. On the other hand, if my physician had prescribed the 1 mg tabs as opposed to the starter pak my co-pay would amount to $60, a subtstantial savings. Have you any suggestions as to how my physician should write the prescription for the tabs?
Respectfully,
David Romero
Comment by david romero — October 28, 2007 @ 2:25 pm
You only use the 0.5mg tablets for a week. Refills will be for the Continuing Month pack which will all be 1mg tablets.
Look at it this way: it’s cheaper than smoking.
Comment by RJS — October 28, 2007 @ 5:06 pm
To RJS:
You’re right. I decided it’s better to cough up the money than
cough up my lungs.
Comment by david romero — October 30, 2007 @ 5:47 am
Comment by RJS — October 30, 2007 @ 7:34 am
I have been off chantix for 3 months now, the side effects have been terrible. Depth perception problems, short term memory loss , balance issues, i am unable to drive work etc. this drug has been a nightmare for me. I wouldn’t take it if you payed me to….!!!!!
Comment by Jerry White — November 8, 2007 @ 10:08 am
jerry, i am suffering the same problem. I thought I was going crazy, even seen a psy, gen doctor and a neurologist. Feel like emailing me I would like to talk to you more personally. brandonrcampbell at gmail dot com
Comment by Brandon Campbell — January 2, 2008 @ 6:46 pm
Jerry and Brandon, Did you smoke while you were taking Chantix? When you were taking it did you feel calm, happy at peace.
I have enough problems w/short term memory. Now I worried. I just started the starter pack
Comment by Tony Akim — February 21, 2008 @ 3:12 am
I use chantix I quit for 3 months. I smoke again… today back on chantix… side effects are bad but I will suffer to quit… this time I hope for good.
Comment by Joanna S — March 6, 2008 @ 3:18 pm
Boy, I am glad so many people have had good luck with this medication. I sincerely mean that! I am not one of them. I thought I was going totally nuts when I was on this medication.
I did OK the first week. It was when the starting amt. doubled I began to have problems. Then when it doubled again, I was crying all the time, extremely nervous and I am not a very nervous person normally, at all. I was so agitated I actaully worried I might attack someone. The side effects just were not worth it for me.
Comment by MCA — March 6, 2008 @ 5:32 pm
I took Chantix last year for about 1 month. I was out of town when I ran out of the prescription and decided that since I did not smoke for a month I should be good. It’s been over a year and I have not smoked yet. I loved to smoke so giving it up was a hard concept to accept - however, I made a plan and stuck to it. Instead of wallowing in pity - I took up walking, running, lifting weights, bycycle riding, and a lot of other outdoor activities. I cannot believe how healthy and fit I feel today. I’ve lost 40 pounds while doing all of this.
With all that said, the symptoms I had with Chantix are as follows.
Some nausea - especially if I took the medicine on an empty stomach - therefore, I made sure I had enough food in my stomach when taking the medicine.
Short term memory loss - I noticed this was more acute when drinking alcohol.. I’ve never had a situation where I lost my memory when drinking alcohol. However, after taking this medicine I noticed that I began to lose it. It was a little scary at first because I didn’t remember where I was or who I was with or what was going on. Luckily nothing serious happened - but to this day it still happens occasionally. More study needs to be done in this area.
Was it worth taking Chantix - for quitting smoking I believe it helped me - everyone is different and if you don’t go into this with an plan then you’re not going to quit - you need to change your mindset and your daily activities in order to overcome the smoking. Taking Chantix for the month while I was embarking on my new journey helped me get through the worst “hunger” pangs for smoking early on. After that I just kept working out and doing whatever I could to stay busy and active (without eating like a pig). So yes it was worth it for me to take Chantix for the month to quit smoking.
Comment by Kevin from PA — March 27, 2008 @ 4:29 pm
My brother in law was using Chantix and said he had wild thoughts and very vivid creepy dreams and totally swore off the stuff after 4 days. I thought he was a wimp.
In the meantime, I got a script for it myself and took it to the pharmacy to get filled. Only to find out that my insurance didn’t cover it and it cost $149.99 for the first month. Of course I could not afford that. I’m a single working mother on a strict budget, so I decided to go cold turkey. (My particular generic brand of cigarettes from the rez cost me less than $9 per carton and that would last me well over 2 weeks)
Anyway, knowing my brother in law was tossing his in the trash, I asked if I could have them. I had had at least 4 cigarettes a day for a week that I couldn’t give up so I needed the help.
I popped the first pill while I read the insert which described the dosage, etc. It said start with the white pills .05 ml for 3 days, then those same white pills twice a day for the next 4 days. It occured to me at that point, that the pill I just took was blue. I looked at the package and the outside box clearly says starter pak, while all 4 of the ‘blue’ inserts clearly say continuing pak.
All of a sudden, it’s clear why the ‘wimp’ felt like he was in a freak show. It’s packaged wrong. There are no low dosed pills. Hopefully I’ll sleep okay tonight and all will be well for me. I’ll cut them in half and take the proper dosage from here on out.
I can’t help wondering how many times has this happened though…Scary.. just plain scary.
Comment by Melody — March 27, 2008 @ 7:55 pm
[...] Check out another blogger’s packaging photos of Chantix. [...]
Pingback by Ambidextrous Blog » Pharmaceutical comfort rituals — April 7, 2008 @ 12:45 am
This is my third time around with Chantix. First time - I quit smoking 8 weeks, succumbed when I went on an out of town with friends - who smoked during trip (when they normally wouldn’t smoke in their vehicle) and booked me into a smoking room. Alas - I was hooked again. 2nd time I just couldn’t deal with the side effects (mostly nausea and insomnia - I’m already battling a sleep disorder). But - I HAVE to do this - quit smoking. One thought comes to mind - some meds are prescribed taking weight of patient into consideration. Is it possible the ’standard titrated’ dose (1.0 mg bid) is just too high a dose for some people? I do notice in ‘how supplied’ there are bottles (of 56) of 0.5 mg; irony is most pharmacies seem to only carry the combo packages and the few that offer 0.5 mg - it is the same price as 1.0 mg (#56). (Pfizer website says the tablets can’t be cut - which I was considering. If anyone has reduced titrated dose to 0.5 mg bid I’d appreciate reading your experience - did it cut down on side effects? Was treatment still successful?
Comment by Colleen — April 20, 2008 @ 4:38 pm
Yes, you can get the 0.5mg tablets in bottles of 56 without the fancy packaging. The pharmacy may have to special order it for you, but we have a couple of people who cannot tolerate the full 1mg twice a day.
Comment by RJS — April 20, 2008 @ 9:29 pm
is it safe to drink with this pill??
Comment by Diana — April 23, 2008 @ 8:39 pm
Yes, there’s no drug interaction between Chantix and alcohol.
Comment by RJS — April 29, 2008 @ 11:38 pm