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:

  1. How does Chantix come?
  2. Normal Chantix Use: prescribing a course of Chantix
  3. Normal Chantix Use: the first month (photos begin)
  4. Normal Chantix Use: Month 2 and beyond
  5. 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:
Chantix Starter Pack photo #1

Inside this main pack you’ll find the following mini-packs:
Chantix Starter Pack contents

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:
Chantix Starter Week 1

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:
Chantix Continuing Month Pack

Closeup.

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.

[tags]Chantix, pharmacy, medicine, varenicline, smoking, smoking cessation[/tags]

60 thoughts on “The ins and outs of prescribing Chantix (varenicline): an illustrated How-To guide

  1. 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.

  2. 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.

  3. 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.

    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.

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  5. 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…

  6. 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.

  7. 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.

  8. 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.

  9. 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?

  10. RJS, any particular reason why your pharmacy doesn’t do the bottle of 1mg tablets?

    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.

  11. what happens when you get an rx that says chantix 1 mg #60 or #90 i have seen both.

  12. 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.

  13. 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

  14. 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

  15. 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

  16. 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.

  17. To RJS:

    You’re right. I decided it’s better to cough up the money than
    cough up my lungs.

  18. 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….!!!!!

  19. 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

  20. 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

  21. 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.

  22. 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.

  23. 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.

  24. 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.

  25. 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?

  26. 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.

  27. I used Chantix and quit for 8 months. After a tragic event, I started smoking only one or two a day. I tried to use Chantix again but it was not nearly as helpful as the first time. Do you know of others with a similar experience? I wondered if waiting longer before trying it again would be helpful?
    CK

  28. Cherie,

    I assume you mean 1-2 cigarettes/day. Keep in mind that Chantix is only useful for nicotine addiction. There are two parts to cigarette addiction: chemical and psychological. You’ve beaten the chemical addiction, now it’s time to beat the psychological addiction. By that, I mean that when you need to get away from something for a few minutes to “clear your head”/”get some air” — you go for the cigarette. Or you associate being done with dinner with smoking a cigarette. These are psychological triggers that cause you to want a smoke, and these feelings can persist for years.

    This is actually why Chantix gives you access to support programs — because chemical dependence is only one small part of the addiction equation. You’ve gotten over the chemical part, so Chantix isn’t going to help you much. You need a support system to help you with the rest.

  29. I took Chantix for 1 month starting July 7. I wanted to quit smoking before school started back in for the year. I did. I have been quit for 14 weeks now. Great feeling. I have, however, been eating like a piggy, and have experienced memory loss since taking the medication. I only took it for one month. THis is very bothersome to me because I feel as if I am unable to accomplish anything at home or work. VERY frustrating. Have there been any real studies done into side effects like this? I am glad that I found this website because I felt like I was losing my mind.

  30. I just received the prescription from my insurance, but they said they were not able to fill the starter pak. Doesnt make much sense to me that they could send me 2 months worth of the meds, but not the starter pak. Can I just cut the pills in half for the first week?
    I tried taking Chantix before, and felt like I was going to attack anyone who was coming near me, but this time I am just going to have to deal with the side effects if it means it will help me stop smoking.
    Any ideas on how to start the first month without the starter pak? Thanks.

  31. I used Chantix 1year ago. Quit for 80 days. No probs, no side effects… except the creepy dreams which I found interesting.
    I started smoking again going out of town to a concert… Then went back to my Dr. and he prescribed it again…. I never really “wanted to quit” at that point.. so I never finished taking them…. threw them away.
    I wonder if it is OK to (now over a year later) ask for another prescription? Is there any harm in “re-taking’ the drugs?

  32. I am currently taking Chantix and consider myself a non-smoker now. Although there have been triggers such as being out drinking with friends that I have had one or two. I don’t crave it the next day so that’s nice. Six cigs in 12 weeks, I’m okay with this. NOT my point though… I am somebody who seems to get every side effect listed. I wanted to share some things that have worked for me. I was getting “sick” everyday when I went to the 1 mg tabs. Still wanting to stick it out I asked my doc for a prescription of promathazene (sp?) an anti-nausea med. I take it one hour before my chantix and it helps sooo much.

    Before starting I suggest two things. 1) Change your brand of cigarette to an all natural brand without the additives. This will help with the cravings. 2) Change the times you smoke, such as wait an hour after eating, don’t smoke in the car, just switch your habit times.

    I’ve had kidney pain with Chantix along with blood in urine. Thankfully this has resolved. The memory problems is a major problem for me since I already have this problem due to other medical stuff. Weird is how I usually resort to a more complicated word to describe something versus the simple word.

    Insomnia is horrible for me, luckily I work from home and make my own schedule. Ambien, Tylonol PM, Melatonin have been somewhat helpful, but not a cure.

    As for aggitation… I kind of welcome it. I have no patience for slackers and those who have a false sense of entitlement. Where I used to enable these types of people, I no longer can stand to have a two-minute conversation with them. Possibly an upside for me? :) Although I do find myself very opinionated lately and not my amiable self.

    GOOD LUCK

  33. I started taking Chantix about a week and a half ago. No side effects for me which is great. The first week was really good. By the 5th day I really did not desire a cigarette. However now that I’m on the second week I find myself sometimes wanting one. Now I go to work and I don’t smoke until lunch and even then maybe one. After lunch no cigarette. I sometimes smoke one on the way home, but that would be it for the rest of the day. My husband smokes and he will smoke right next to me at home and it will not bother me. What can I do the help me during the day at work? I don’t think it is the chemical part anymore as much as I do the psychological part. Any ideas would be great!

  34. For all of you who are having problems with the psychological triggers during smoking cessation, buy a bag of Charms Blowpops. When you’re having a craving, pop one in your mouth and twirl the stick back in forth. It helps keep your hand busy, mimics the oral part of smoking and the gum inside helps clean your teeth in the process (ie. the yellow stains).

    I quit using nicotine patches and just used the pops to stop cravings. The plus side was how white my teeth were after 2-3 weeks, crazy what cigarettes do to them.

    Good luck!

  35. I Love Chantix! I tried everything possible to quit smoking and nothing seemed to work – mainly because I never wanted to quit. I enjoyed smoking. It was health issues that eventually convinced me it was time.

    Chantix has been a life saver. One solid week of smoking while I was on the pill, and then poof, I lost interest. The tobacco lost it’s flavor, I wasn’t getting cravings during work or in the middle of the night.

    But Chantix isn’t for everyone. Side effects that I experienced – Trouble falling asleep, trouble staying asleep, extremely vivid dreams, Lots of sleep issues in general, short term memory loss that persisted for a month after I stopped taking chantix, and seeing things that weren’t real.

    So basically, lots of psychological effects. It plays tricks on your eyes while you are asleep and awake. I hear its a different experience for everyone, but even with the trouble, I would highly recommend to anyone looking to toss the smokes.

  36. My husband and I want to quit smoking but can’t afford Chantix right now, as I’m not working. Our insurance won’t cover the product either. I know someone who can get the product for a mere $3.00. They used their Starter Pack though, so she gave me the Continuing Week Pack. Will this product be effective without using the Starter Pack?
    Thanks!
    Cathy – March 8th, 2010

  37. I am glad there are lawsuits to get some REAL answers to HOW this poison works. You people have NO idea for sure and are just guessing. You still are not helping the ones who took this crap with no idea of the side effects before it got the BLACK BOX warning it does notw. As one of those who was seriously INJURED for LIFE by this drug I as disguested by your greed and IGNORANCE!

  38. I had my own prescription but it was filled wrong by the pharmacy. They called my doctor for clarification and when I went to get it it was still wrong. Asked them to send to a different pharmacy and after 3 days of arguing with them it was finally transferred. Went to get at new pharmacy and it is still wrong. I don't understand why it is so difficult. It is prepacked in blister pack envelopes and the envelopes are in a box. What is so hard about simply giving the patient the correct set of packages. When I went to get it today they were giving me a full 84 days and it was in a bottle rather than the blister pack envelopes and they wanted me to pay $400.00 for the full presccription they had put into one BOTTLE pills.

  39. Because your physician wrote it wrong. When they called to confirm it, the physician confirmed the original instructions. The pharmacy can't change prescriptions without getting the prescriber's approval.

    Not the pharmacy's fault. If you want it a specific way, you'll need to take it up with your doc.

  40. Male 50 years old and have smoked about a pack a day for 35 years. A friend gave me four packs of the 1mg blue pills and told me to take one a day to try to quit. I didnt follow their plan with the 1/2 mg starter packs but it still worked great for me. I found that I had very little desire to smoke after the fourth day and quit on day six. After a few weeks my doctor gladly phoned in a script whe I phoned in and asked her to. I still take one blue pill a day and have no desire to smoke even while out for drinks with other smokers. The results for me are unbelievable, I cant believe how easy its been. Three months and still no cravings. I only have one side effect and that is the vivid dreams but that doesnt bother me I still feel very rested, most mornings I feel even more rested than before taking the Chantix. I think that this is really great for any one who never thaought they could quit or would suffer through unbearible withdrawls. My freind really did me a huge favor by talking me into trying this is may have added years to my life and it was EASY.

  41. hello I had gotten the chantix about 6 months ago and it was siting on my coffe table, my dog chewed up the starter pack and now all I have is the continuing packs (2) no pills were taken as of yet and I cant afford another prescription, how do I go about taking it now that the starter pack is gone the continuing packs are 1mg, thank you desperate to stop smaking I smoke 2 1/2 packs a day and I know I am doing severe damage to my lung because Im starting to coff up flem and chunks, sorry I know its nasty but you need to know the severity of why I have to quit, thanks again. statewidedb@aol.com

  42. What I cannot figure out, you say that even Medicare and Public Assistance is paying for this drug for our less fortunate to become smoke-free.  I am a retired Marine, started smoking in the Marines some 30 years ago, want to stop, but Tricare will not cover the cost of the drug.  But some of the folks on public assistance can live longer than my old Veteran ass because I will not pay the prices to take the pill.  Thank you U.S. Government!

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