Clinical experience of varenicline for smoking cessation

Varenicline, a partial agonist/antagonist of the alpha4beta2 nicotinic acetylcholine receptors, is effective in smoking cessation, which was demonstrated by several randomized, controlled clinical trials.

In the present study, we evaluated the practical efficacy of varenicline for smoking cessation in patients who visited a pulmonary clinic at a university-affiliated hospital in South Korea.

Varenicline was prescribed to smokers after brief, standardized, individual counseling from June 2007 to January 2009. Their medical records were reviewed retrospectively. Their smoking status was assessed by telephone interview from October 2007, and final, confirmative telephone inquiry was performed in April 2009. The primary question was 4-week continuous abstinence from smoking between 9 and 12 weeks.

Overall, 217 current smokers (200 men and 17 women) who were prescribed varenicline were enrolled. On average, participants were 52 years old and had 35 pack-year of smoking history. Nineteen participants (8.8%) did not purchase the drug, and nine (4.1%) who purchased did not take the medicine. Contact was impossible for 32 (14.7%). Fifty participants (23.0%) succeeded, while 107 (49.3%) failed in abstaining from smoking from 9 to 12 weeks. Only 32 (14.7%) had a prescription of varenicline for 12 weeks or more. Most participants (80%) reported their desire for smoking reduced after taking varenicline. Common adverse events were gastrointestinal symptoms and neuropsychiatric symptoms.

Although varenicline was effective in reducing the desire to smoke, poor dosing compliance needs to be overcome in clinical practice.