Varenicline Pharmacy Workbook

Report
COMMUNITY PHARMACY
WORKBOOK 2014-15
PUBLIC HEALTH DORSET
Supply of varenicline (Champix ®)
YOUR DETAILS
Name:
Position:
Pharmacy:
Date:
Notes:
INTRODUCTION

Community pharmacies are now able to supply
varenicline for smoking cessation via patient
group direction (PGD).
AIMS AND OUTCOMES

To improve access and choice for patients who
want to stop smoking

To improve primary care capacity by reducing
medical practice workload related to smoking
cessation
WHEN CAN I SUPPLY VARENICLINE?

The patient must be suitably willing to quit and
willing/able to attend 1-1 sessions

Main contra-indications (refer to PGD for full list):
 Pregnancy and/or breastfeeding
 Patient has taken varenicline/bupropion
previously in an attempt to stop smoking
 Patient under the age of 18
 Patient not willing for information to be passed to
GP

Where the patient does not meet criteria for supply
under the PGD, they can be signposted to other
health and social care professionals
WHEN SHOULD I SIGNPOST?

If the patient wishes to stop smoking but you
cannot supply varenicline under the PGD:

Discuss alternative therapies for smoking
cessation

Refer to Public Health Dorset for further advice

Refer the patient to their GP
WHO CAN SUPPLY UNDER THE PGD?

ONLY a pharmacist who has carried out the
required training can undertake consultations and
supply the medication.

Technicians are not eligible to supply medicines
under PGD.
CONSIDERATIONS

When pharmacotherapy is required to assist in
supporting a quit attempt patients should be
assessed based on medical history, previous use
and client choice.

NRT or varenicline may be used as a first line
option for smoking cessation.

Patients should be fully informed of the risks and
benefits of the available treatment options through
verbal and written information.

Note: repeat courses of varenicline are not
recommended and are not covered by the PGD.
THE FIRST CONSULTATION
Complete the relevant stage on PharmOutcomes.
 Follow the varenicline PGD checklist form, ensuring
that all the relevant information is provided to the
patient. This information includes:

 Treatment schedule
 Administration
 Side effects
 Dose tapering
 Consent to share
information
 General stop smoking
advice
 Follow-up
 Where to get more
information
THE FIRST CONSULTATION (continued)
Check the patient understands advice given and
ask them to sign the consultation form.
 Keep this form as a record of the consultation and
patient consent.
 Provide the first 2 weeks treatment as a titration
pack and arrange the follow up appointment.

REQUIREMENTS FOR ONGOING
CONSULTATIONS





Update on PharmOutcomes.
Provide a further 2 week supply of varenicline. (Do not
supply any more than 2 weeks at any one time).
Arrange next follow up appointment.
Patients who experience side effects should be advised
to seek advice from the pharmacist, or their GP;
varenicline is a black triangle medicine (T) and all
suspected side effects should be reported to the MHRA
on a yellow card.
Patients should be advised to discontinue treatment and
seek prompt medical advice if they, or their family or
carers notice that the patient has developed agitation,
depressed mood or suicidal thoughts.
DOSE AND FREQUENCY
The recommended dose is 1 mg oral varenicline twice daily with
a 1 week titration at the beginning and end of the 12 week
period.
Days 1-3: 0.5mg (white) once daily
Days 4-7: 0.5mg (white) twice daily
Day 8 onwards: 1mg (blue) twice daily
End of treatment reduction (starter pack in reverse)
1mg (blue) twice daily for 7 days then 0.5mg (white) twice daily
for 4 days then 0.5mg daily for 3 days
Patients who cannot tolerate side effects, but are still motivated
to continue treatment may have their dose lowered temporarily
or permanently to 0.5mg twice daily
Provision for the first two weeks supply is provided as a titration
pack, which contains one clear blister of 11 x 0.5 mg film-coated
tablets and a second clear blister of 14 x 1 mg film coated
tablets.
ADMINISTRATION AND PAYMENT

A record of each supply of varenicline must be
made on the PMR.

The patient’s GP must be notified of the supply of
varenicline by fax. It is the responsibility of the
pharmacist to inform the patient’s GP.

The pharmacy should submit a claim on
PharmOutcomes at each stage of supply for
payment for supplies of varenicline (part of normal
claim).

The pharmacy will be paid £6 for each initial supply
of varenicline, plus the basic drug cost and £2
dispensing fee for each 2 week supply.
CONTRACT AND PGD SIGN UP SHEET

If your pharmacy does not yet offer the smoking
cessation service, you must ensure that you sign a
contract to provide this service and sign a copy of the
varenicline PGD sign up sheet. Inform Public Health
Dorset of who is trained to provide this service.

If your pharmacy already provides the smoking
cessation service but you are participating in the supply
of varenicline via the community pharmacy PGD you
must ensure you sign a copy of the PGD sign up sheet.
Inform Public Health Dorset of who is trained to provide
this service.
NEXT STEPS
 Once
you have studied the PGD and
this workbook please complete and
submit the questions and declaration by
clicking on the link below:
 Varenicline
PGD workbook questions
QUESTIONS?
If you have any questions after reading through this
workbook and PGD please contact:
Emma Wilson
[email protected]
01305 225869
or
Michelle Homer
[email protected]
01305 225878

similar documents