Varenicline

Provide patients with counseling and educational support. Set a target "quit date". Begin therapy 1 week before target quit date. Alternatively, may begin therapy and then quit smoking between Days 8 and 35 of treatment. Take after eating with a glass of water. Initially 0.5mg once daily on Days 1–3, then 0.5mg twice daily on Days 4–7, then 1mg twice daily thereafter. May reduce dose if intolerable nausea or other adverse effects occur. Treat for 12 weeks; may continue 12 more weeks if patient successfully stops smoking to further increase the likelihood of abstinence. Patients who are not able or willing to quit abruptly: consider a gradual approach; begin varenicline dosing and reduce smoking by 50% from baseline within the 1^st four weeks, by an additional 50% in the next four weeks, and continue reducing with the goal of complete abstinence by 12 weeks; continue for a total of 24 weeks of treatment. If patient motivated to quit and did not succeed, encourage another attempt with varenicline once factors contributing to failed attempt have been addressed. Severe renal impairment: initially 0.5mg once daily; may titrate to max 0.5mg twice daily. ESRD with hemodialysis: max 0.5mg once daily if tolerated.