When the nicotine receptor partial agonist varenicline (Chantix – Pfizer) was first marketed, The Medical Letter concluded that it was moderately effective in increasing smoking cessation rates.1 More recent publications and the clinical experience of Medical Letter consultants now suggest that varenicline is the most effective drug available for this indication, more effective than nicotine replacement therapy or bupropion SR (Zyban).2,3 A word of caution: exacerbations of psychiatric illness have been reported in patients who took higher-than-recommended starting doses of varenicline.4,5

1. Varenicline (Chantix) for tobacco dependence. Med Lett Drugs Ther 2006; 48:66.

2. P Wu et al. Effectiveness of smoking cessation therapies: a systemic review and meta-analysis. BMC Public Health 2006; 6:300.

3. K Cahill et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2007; (1):CD006103.

4. R Freedman. Exacerbation of schizophrenia by varenicline. Am J Psychiatry 2007; 164:1269.

5. I Kohen and N Kremen. Varenicline-induced manic episode in a patient with bipolar disorder. Am J Psychiatry 2007; 164:1269.