1	Tobacco Dependence, Treatment Strategies and Overview of ^PrCHAMPIX^TM (Varenicline Tartrate)
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5	Smoking Prevalence in Canada: 19% Almost 5 Million Smokers
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9	What’s in a Cigarette? Nicotine is responsible for the addiction, but other chemicals contribute to its addictive effects¹ Smoking cigarettes with lower tar and nicotine provides no health benefit compared to regular cigarettes¹
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11	The Cycle of Nicotine Addiction Nicotine binding causes an increase in dopamine release¹ Dopamine gives feelings of pleasure and calmness² The dopamine decrease between cigarettes leads to withdrawal symptoms of irritability and stress^3,4 The smoker craves nicotine to release more dopamine to restore pleasure and calmness^2,3 Chronic exposure to nicotine causes desensitization and compensatory receptor upregulation^2,5 Withdrawal symptoms occur in the prolonged absence of nicotine (4-6h), as nicotine levels decrease, and receptors become resensitized¹
12	Quitting Smoking: A Long and Difficult Journey The majority of smokers are motivated to quit² Most try to quit without pharmacological assistance³ 87% of current smokers have tried to quit smoking at least once before⁴ 19% of smokers report craving is the most common reason why quitting smoking is considered difficult⁴
13	A Comprehensive Approach to Smoking Cessation Smoking addiction has two main components that need to be addressed: one related to the pharmacological action of inhaled nicotine and the other related to behavioural factors^1-3 Advice and behavioural support increase the chances of quitting successfully^4,5
14	Brief Tobacco Intervention Using the “5 A”s Identify and document tobacco use In a clear, strong, personalized manner, urge smoker to quit Is the smoker ready to make a quit attempt? Use counselling and pharmacotherapy to help him/her quit Schedule follow-up contact Preferably within 1 week after the quit date
15	Pharmacotherapy for Tobacco Dependence^1-4 Nicotine replacement therapy (NRT) Long acting Patch Short acting Gum Inhaler Bupropion SR Varenicline A new smoking cessation aid
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18	Varenicline binds to the a4b2 nicotinic acetylcholine receptor (nAChR) with simultaneous partial agonist and antagonist activities ACTIVITY 1: Partial agonist Varenicline binds to the receptor, partially stimulating dopamine release ACTIVITY 2: Antagonist Because varenicline is bound to the receptor, it prevents the binding of nicotine
19	CHAMPIX (Varenicline) Indication and Dosing Information Indicated for smoking cessation treatment in adults in conjunction with smoking cessation counselling Treatment period is 12 weeks An additional course of 12 weeks of treatment may be considered for patients who have successfully quit at the end of 12 weeks Varenicline is supplied for oral administration in 2 strengths: 0.5 and 1.0 mg To optimize therapy success, patients should be titrated up to the maximum recommended dose of 1.0 mg BID, using the following 1-week titration schedule:
20	Varenicline Safety Information Established safety and tolerability profile assessed in approximately 2,300 subjects In general, onset of adverse events occurred in the first few weeks of therapy and severity was generally mild to moderate The most commonly observed adverse events associated with varenicline (>5% and twice the rate seen in placebo-treated patients) were nausea, abnormal dreams, constipation, flatulence, and vomiting Discontinuation rate due to nausea was only 2.7% (vs. 0.6% for placebo)
21	Varenicline Significantly Reduced Symptoms of Craving, Withdrawal, and the Reinforcing Effects of Smoking vs. Placebo^1-3
22	CHAMPIX (Varenicline) Key Points to Keep in Mind: Identify patients who are motivated to quit smoking, since motivated quitters are more likely to succeed^1,2 Prescribe a 12-week course of CHAMPIX treatment² Have patients set a target quit date 1-2 weeks into treatment^2-4 The pivotal studies utilized a day 8 quit date^3,4 Reassess patients after 12 weeks For those who were successful, an additional course of 12 weeks may be considered to help them stay quit² Encourage enrollment in a patient support program
23	Tobacco Dependence, Treatment Strategies and Overview of ^PrCHAMPIX^TM (Varenicline Tartrate)