Understanding Varenicline and Smoking
Varenicline, formerly sold under the brand name Chantix, is a prescription medication specifically designed to help adults quit smoking [1.3.1]. It is a non-nicotine pill that works by targeting nicotine receptors in the brain [1.2.4]. A common question for those starting this treatment is, can you still smoke while taking varenicline? The answer is not only yes, but it is often part of the recommended process [1.3.3].
There are several FDA-approved ways to begin treatment with varenicline, all of which involve an initial period of taking the medication while still smoking [1.3.3, 1.3.4]:
- Fixed Quit: You set a quit date and begin taking varenicline one week prior. You can continue to smoke during this first week, but you must stop on your chosen quit date. This method helps the medicine build up in your system [1.3.3].
- Flexible Quit: You start taking varenicline and then choose a quit date that falls between 8 and 35 days after you begin treatment [1.2.2].
- Gradual Quit: If you are not ready to quit abruptly, you can start varenicline and gradually reduce the number of cigarettes you smoke over a 12-week period. The goal is to cut smoking by 50% in the first four weeks, another 50% in the next four, and reach complete abstinence by the end of the 12 weeks [1.3.4].
If you have a slip-up and smoke after your quit date, it is not considered a failure. Medical advice encourages you to continue taking varenicline and get back on your quit plan [1.2.1, 1.2.6].
How Varenicline Works
Varenicline's effectiveness lies in its dual-action mechanism as a partial agonist at the α4β2 nicotinic acetylcholine receptors [1.4.1]. This means it does two things simultaneously:
- Reduces Cravings and Withdrawal: It provides mild stimulation to these receptors, which eases the symptoms of nicotine withdrawal that occur when you stop smoking [1.4.6].
- Blocks Nicotine's Effects: It occupies the receptors, preventing nicotine from binding to them. This blockage means that if you do smoke a cigarette, you won't experience the same rewarding, pleasurable effect, making smoking less enjoyable [1.2.3, 1.4.1].
This mechanism makes varenicline a highly effective option. Studies have shown it is more effective for long-term smoking cessation than Nicotine Replacement Therapy (NRT) and bupropion [1.5.2, 1.5.1]. In some cases, combining varenicline with other aids like bupropion or NRT may increase effectiveness further, though this can also increase the likelihood of side effects and should only be done under medical supervision [1.5.1, 1.2.4].
Common Side Effects and Important Considerations
Like all medications, varenicline has potential side effects. The most common is nausea, which affects about 30% of patients [1.7.5]. To minimize this, it's recommended to take the medication after eating and with a full glass of water [1.3.2]. Other common side effects include unusual or vivid dreams, insomnia, constipation, and headache [1.7.5].
There are also more serious but rare risks to be aware of:
- Alcohol Interaction: Varenicline can increase the intoxicating effects of alcohol and may lead to unusual or aggressive behavior [1.6.1, 1.6.3]. It is advised to reduce alcohol consumption until you know how the medication affects you [1.6.1].
- Neuropsychiatric Events: While a previous FDA boxed warning was removed in 2016 after further studies, there remains a rare risk of changes in mood or behavior, agitation, depression, or suicidal thoughts [1.7.4]. Any such changes should be reported to a doctor immediately [1.2.2].
- Seizures: There have been rare reports of seizures. Patients with a history of seizures should discuss the risks and benefits with their doctor [1.6.1].
- Cardiovascular Events: People with pre-existing heart or blood vessel disease should discuss the risks, as studies have shown a slightly higher likelihood of events like heart attack or stroke compared to placebo [1.2.2].
Quitting smoking itself can impact how your body metabolizes other drugs. For instance, dosages for medications like warfarin (a blood thinner), theophylline (for asthma/COPD), and insulin may need adjustment after you quit [1.8.2]. Always inform your healthcare provider of all medications you are taking.
Comparison of Smoking Cessation Aids
| Feature | Varenicline | Nicotine Replacement Therapy (NRT) | Bupropion (SR) |
|---|---|---|---|
| Mechanism | Partial nicotine receptor agonist; reduces cravings and blocks nicotine's rewarding effects [1.4.1]. | Delivers controlled doses of nicotine to ease withdrawal symptoms [1.2.4]. | Atypical antidepressant; mechanism for smoking cessation is not fully understood but affects brain chemicals related to craving. |
| Contains Nicotine | No [1.2.3] | Yes (e.g., patch, gum, lozenge) [1.2.4] | No |
| Prescription Required | Yes [1.2.3] | No (for most forms) [1.2.4] | Yes |
| Common Side Effects | Nausea, unusual dreams, insomnia [1.7.5]. | Skin irritation (patch), mouth soreness (gum), headache [1.8.6]. | Dry mouth, insomnia [1.5.6]. |
| Effectiveness | Generally considered the most effective single pharmacotherapy; superior to both NRT and bupropion in multiple studies [1.5.2, 1.5.6]. | Doubles the chance of quitting versus placebo [1.5.6]. | Less effective than varenicline but doubles the chance of quitting versus placebo [1.5.6]. |
Conclusion
Not only can you smoke when you first start taking varenicline, but doing so is a key part of the standard treatment protocols designed to help you quit successfully [1.3.3]. The medication works by gradually reducing the pleasure derived from smoking and mitigating withdrawal symptoms, paving the way for you to stop completely within a few weeks [1.4.5]. While highly effective, it's crucial to follow your doctor's dosing schedule, be aware of potential side effects and interactions, and utilize the support of a broader smoking cessation program for the best chance of long-term success [1.2.3, 1.2.7].
For more information and support, you can visit the National Cancer Institute's Smokefree.gov initiative: https://www.smokefree.gov [1.2.3].
