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Varenicline: implications for the field
Alex Bobak, GP, Wandsworth PCT, London
Abstract
Varenicline (Champix) is the first in a new class of therapy for smoking cessation and has been available on NHS prescription since December 2006. It binds specifically to a subtype of nicotinic receptor (α4β2) implicated in nicotine addiction. It has a greater affinity to the receptor than nicotine and acts by partly blocking the receptor and partly stimulating it. Studies comparing safety and efficacy with bupropion (Zyban) have been favourable and a study comparing nicotine patch is due for publication this year.
Despite offering an important new treatment option to UK smokers there have been numerous issues which have effected its use.
PCO approval
In a climate of cost cutting any new product faces considerable scrutiny by PCOs. This has meant delay in approval in some regions and variable recommendations for use across the country. The Scottish Medicines Consortium and The National Institute for Health and Clinical Excellence have now both approved varenicline.
Access to prescriptions
Being a prescription only medication is a particular barrier to its use given that very few stop smoking advisers are able to prescribe. There is a reliance on GPs to prescribe which at least makes the patient pathway more complicated and can be a barrier in itself. Patient group directions (PGDs) and improved communication with GPs could help the situation.
Side effects
Varenicline is generally well tolerated; the most common side effect is nausea which occurs in about a third of those who take it. Measures can be taken to reduce nausea.
The session will focus on these and other issues and share ways to overcome them.
Biography
Dr Alex Bobak is senior partner of a General Practice in Wandsworth, South London. He has been running specialist smoking cessation clinics as a GP for several years and is the first GP with Special Interests (GPSI) in Smoking Cessation in the country. He has carried out research into pharmacological treatment in smoking cessation.
Working on a chest ward as a junior doctor led him to become a passionate campaigner on the dangers of smoking. He believes that helping smokers to stop is a most important part of Primary Care and is a regular speaker on smoking cessation at meetings throughout the UK.
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