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About Champix

Champix tablets (from Pfizer) contain varenicline, which is used to help stop smoking. Champix reduces craving and other nicotine withdrawal symptoms. It also makes smoking less pleasurable.

Champix (varenicline) works by sticking to the nicotinic receptors in the brain, blocking nicotine itself from being able to attach, and preventing the nicotine 'buzz'. Champix is a 'partial agonist' which means that it does give a small partial 'buzz' effect which is enough to reduce nicotine cravings and withdrawal symptoms, but without the full enjoyment of smoking.

A person taking Champix will find it easier to stop smoking and will be less tempted by nicotine.

Effects of nicotine withdrawal

Nicotine triggers the release of pleasure chemicals, including dopamine in the brain. People find that smoking reduces stress and anxiety, increases concentration, improves performance, and helps with mood. However many of these 'positive' effects are in reality caused by the reduction of nicotine withdrawal symptoms, rather than as direct benefits from the nicotine and dopamine release. The strength of the withdrawal symptoms leads to a very strong addictive effect.

Data from NICE, 2021, What withdrawal symptoms is a person likely to experience when they stop smoking?

Symptom of withdrawal	Occurrence	Duration
Cravings for nicotine	70%	> 2 weeks
Appetite increase	70%	> 10 weeks
Restlessness	60%	< 4 weeks
Poor concentration	60%	< 2 weeks
Depression	60%	< 4 weeks
Irritability, anger, aggression	50%	< 4 weeks
Poor sleep	25%	< 1 week
Light headed	10%	< 48 hours

The habit of smoking in certain situations contributes significantly to nicotine addiction. A strategy for tackling the cravings linked to these strong 'smoking-related cues' will usually make a big difference to the quit process.

How to take Champix

A 'quit date' should be chosen before starting Champix. Champix tablets are then started 1-2 weeks before the 'quit date'. There is a starter pack which allows the dose of Champix to be built up slowly over 7 days to reach a dose of one 1mg tablet twice a day. Stop all smoking on the 'quit' day and then continue taking Champix at a dose of 1mg twice daily for a further 10-11 weeks. After a total of 12 weeks, treatment is stopped, by which time smokers should have given-up permanently.

If the usual dose of 1mg twice daily is too strong, and not tolerated, a lower dose of 0.5mg twice daily may be taken.

If a person restarts smoking whilst they are taking Champix, the course of treatment has failed, and they should stop taking Champix. It is not harmful to continue with Champix, but the attempt to quit has failed.

Some people, who do not manage to give up and start smoking again, can try Champix again and can take it for a longer period (up to 24 weeks).

If it is difficult to totally stop smoking, even whilst taking Champix, a regime of gradual reduction to zero over the full 12 weeks followed by a further 12 weeks of Champix with no smoking at all, can be used. However, Champix usually works better if you quit completely within the first 2 weeks.

If extra Champix tablets are taken in error, seek medical advice.

If a dose or doses are missed, do NOT make up the missed dose by taking extra, but resume at the normal daily dose.

Champix can be taken with or without food. Tablets should be swallowed whole with water.

Cautions

Whether you are taking Champix or not, stopping smoking has been associated in some people with depression, suicidal ideation, behaviour changes, and suicide attempts. If you, or a family member, or a friend become concerned about agitation, depressed mood, behaviour changes, or suicidal thoughts or actions, stop taking Champix immediately and consult a doctor. For further details see the Champix patient information leaflet.

Stopping Champix

Some return of nicotine withdrawal symptoms such as depression, increased irritability, sleep disturbance, and an urge to smoke occasionally may occur, if you stop Champix suddenly. If you are troubled by this, symptoms can be helped by a gradual reduction in the dose of Champix before stopping completely.

Pregnancy and breastfeeding

Champix should not normally be taken whilst pregnant or breastfeeding. Nicotine replacement treatment may be preferable to help you to stop smoking in pregnancy.

It is particularly important not to smoke during pregnancy as smoking reduces the oxygen and nutrient supply and prevents healthy development of the baby. In many areas of the UK there are specialist NHS services to assist pregnant women to stop smoking - speak to your midwife for advice.

• Best use of medicines in pregnancy - Varenicline
• NHS - Stop smoking in pregnancy
• RCOG - Smoking and pregnancy patient information leaflet

Driving and using machines

Champix may cause dizziness and sleepiness. If affected in this way, do not drive, cycle, or operate complex machinery.

Suitability of Champix

Dr Fox stop smoking consultations include checks for Champix suitability.

Some people, usually only those with pre-existing heart problems, may very rarely, experience more serious heart or stroke symptoms. Stop Champix and seek emergency medical help in the event of symptoms which may be caused by angina, heart attack, or stroke symptoms.

Champix is not usually suitable for people who have a history of seizures or epilepsy.

A lower dose may be needed in severe renal disease, and Champix should not usually be used in renal failure.

Champix is for use by adults only, not under 18s.

Other medicines and Champix

There are no significant interactions between Champix and other prescription and non-prescription medications. However, stopping smoking, with or without Champix, may alter the effects of theophylline, warfarin and insulin, and the doses may need adjusting. Discuss with your regular doctor.

For further information see the patient information leaflet supplied with Champix. People taking antidepressants should consult their usual doctors before taking Champix.

Do not take other stop-smoking medicines, especially nicotine replacement in the form of gums, tablets, sprays and patches, at the same time as Champix. Research has not shown any added benefit and in fact as nicotine and Champix both work through the nicotinic receptors in the brain, they may actually block each other's actions.

Alcohol

There are some reports of increased susceptibility to alcohol whilst taking Champix.

Side effects of Champix

Most people can take Champix without significant side effects. It can be difficult to assess whether a new symptom is part of smoking withdrawal or caused by the Champix.

The most common effects mentioned include:

• Nausea.
• Nose or throat inflammation.
• Difficulty sleeping, abnormal dreams.
• Headache.

For more detail about potential Champix side effects, see the patient information leaflet.

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Other stop smoking medicines

Alternatives to taking Champix to help you to stop smoking include using nicotine replacement and Zyban (bupropion).

Nicotine replacement is available to buy in pharmacies and some shops in many forms: chewing gum, nasal or oral sprays, lozenges, tablets, and patches, in various strengths. In some circumstances they can also be prescribed. A usual course would last 8-12 weeks.

Zyban is a prescription medication, which contains bupropion and is taken for 7-9 weeks. It works on the brain pathways involved in addiction and withdrawal. There are many interactions and potential side effects, including causing an increase in blood pressure which therefore needs careful monitoring during treatment.

Dr Fox does not supply nicotine replacement or Zyban.

See also NHS - Stop smoking treatments.

E-cigarettes and vaping

E-cigarettes contain nicotine but without a lot of the harmful components of tobacco and so are hoped to be much less harmful to health. They may be a useful way of reducing nicotine cravings associated with stopping smoking. They have not yet been fully research evaluated as an aid to stopping, and are not available on prescription.

See also FAQ Health risks and e-cigarettes.

Improving your chances of quitting

Set a quit date and stick to it.

Seek the support of family and friends. Tell everyone you know that you're quitting.

Most people who stop smoking find that a total, complete stop, with a rule of 'never have just one puff', is the best route to success. Taking one quick puff almost always leads back to regular smoking.

The first few days after quitting are often the most difficult, and you may experience withdrawal symptoms, but this usually starts to improve after the third or fourth day.

Cravings are powerful urges to smoke. As well as being triggered in the situations where you would normally have smoked, they can be triggered by stress, seeing other people smoking, or becoming intoxicated (alcohol or drugs). Before quitting, make a list of your own potential triggers and trigger situations, and how you can avoid them. Have a plan and be prepared to deal with the cravings and temptation.

Some suggestions could be:

• Keeping busy.
• Playing a game on a mobile phone.
• Looking at the Smoke Free app or another 'support to quit' app.
• Drinking a glass of water.
• Changing the environment, for example going into another room or going outside.
• Taking some brisk exercise.

Try not to relieve cravings by eating or having a sweet/biscuit/chocolate. Stopping smoking itself can often increase your general appetite, which can lead to unhelpful weight gain.

It can also be helpful to concentrate on the benefits of stopping smoking, both to your general health and your bank account. Remember the amount of money you are saving. Some people find it helps to have a plan to save that money towards something new or a holiday.

Don't go back to smoking after successfully stopping. Even 'just one puff' can lead to restarting.

If you don't manage to stop or to stay off, then try again. Some people take several attempts to completely quit.

Further information and support

GP surgeries, pharmacies, and local councils may provide access to a variety of stop smoking support services. Also:

• NHS England — the free Smokefree National Helpline on 0300 1231044 or online NHS stop smoking services help you quit
• NHS Better Health - Quit smoking. This offers support via a smartphone app, email programme, text messages, and a Facebook page.
• NHS Scotland - the free Smokeline on 0800 848484, or online NHS inform - Stopping smoking.
• NHS Wales — the free Help Me Quit Wales Helpline on 0800 0852219, or online Help Me Quit.
• NHS Northern Ireland: Public Health Agency — Stop smoking.
• ASH (Action on Smoking and Health).
• QUIT, a national charity which provides telephone support.

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