HIGHLIGHTS OF PRESCRIBING INFORMATION
`These highlights do not include all the information needed to use
`CHANTIX safely and effectively. See full prescribing information for
`CHANTIX.
`
`CHANTIX® (varenicline) Tablets
`Initial U.S. Approval: 2006
`
`
`WARNING: SERIOUS NEUROPSYCHIATRIC EVENTS
`See full prescribing information for complete boxed warning.
`
`
`• Serious neuropsychiatric events have been reported in patients taking
`CHANTIX. (5.1 and 6.2)
`• Advise patients and caregivers that the patient should stop taking
`CHANTIX and contact a healthcare provider immediately if agitation,
`hostility, depressed mood, or changes in behavior or thinking that are
`not typical for the patient are observed, or if the patient develops
`suicidal ideation or suicidal behavior while taking CHANTIX or
`shortly after discontinuing CHANTIX. (5.1 and 6.2)
`• Weigh the risks of CHANTIX against benefits of its use. CHANTIX
`has been demonstrated to increase the likelihood of abstinence from
`smoking for as long as one year compared to treatment with placebo.
`The health benefits of quitting smoking are
`immediate and
`substantial. (5.1 and 6.2)
`
`
`----------------------------RECENT MAJOR CHANGES-------------------------­
`Warnings and Precautions
`
`
`
`Cardiovascular Events (5.4) 12/2012
`----------------------------INDICATIONS AND USAGE--------------------------­
`CHANTIX is a nicotinic receptor partial agonist indicated for use as an aid to
`smoking cessation treatment. (1 and 2.1)
`
`----------------------DOSAGE AND ADMINISTRATION----------------------­
`• Begin CHANTIX dosing one week before the date set by the patient to
`stop smoking. Alternatively, the patient can b egin CHANTIX dosing and
`then quit smoking between days 8 and 35 of treatment. (2.1)
`• Starting week: 0.5 mg once daily on days 1-3 and 0.5 mg twice daily on
`days 4-7. (2.1)
`• Continuing weeks: 1 mg twice daily for a total of 12 weeks. (2.1)
`• An additional 12 weeks of treatment is recommended for successful
`quitters to increase likelihood of long-term abstinence. ( 2.1)
`• Renal impairment: Reduce the dose in patients with severe renal
`impairment (estimated creatinine clearance <30 mL/min). (2.2)
`• Consider dose reduction for patients who cannot tolerate adverse effects.
`(2.1)
`• Another attempt at treatment is recommended for those who fail to stop
`smoking or relapse when factors contributing to the failed attempt have
`been addressed. (2.1)
`• Provide patients with appropriate educational materials and counseling to
`support the quit a ttempt. (2.1)
`
`-----------------------WARNINGS AND PRECAUTIONS-----------------------­
`• Angioedema and hypersensitivity reactions: Such reactions, including
`angioedema, infrequently life threatening, have been reported. Instruct
`patients to discontinue CHANTIX and immediately seek medical care if
`symptoms occur. (5.2 and 6.2)
`• Serious skin reactions: Rare, potentially life-threatening skin reactions
`have been reported. Instruct patients to discontinue CHANTIX and contact
`a healthcare provider immediately at first appearance of skin rash with
`mucosal lesions. (5.3 and 6.2)
`• Cardiovascular events: A meta-analysis of 15 clinical trials, including a
`trial in patients with stable cardiovascular disease, demonstrated that while
`cardiovascular events were infrequent overall, some were reported more
`frequently in patients treated with CHANTIX. These events occurred
`primarily in patients with known cardiovascular disease. In both the
`clinical trial and meta-analysis, all-cause and cardiovascular mortality was
`lower in patients treated with CHANTIX. Instruct patients to notify their
`health care providers of new or worsening cardiovascular symptoms and to
`seek immediate medical attention if they experience signs and symptoms
`of myocardial infarction or stroke. (5.4 and 6.1)
`• Accidental injury: Accidental injuries (e.g., traffic accidents) have been
`reported. Instruct patients to use caution driving or operating machinery
`until they know how CHANTIX may affect them. (5.5)
`• Nausea: Nausea is the most common adverse reaction (up to 30%
`incidence rate). Dose reduction may be helpful. (5.6)
`
`
`------------------------------ADVERSE REACTIONS------------------------------­
`Most common adverse reactions (>5% and twice the rate seen in placebo-
`treated patients) were nausea, abnormal (e.g., vivid, unusual, or strange)
`dreams, constipation, flatulence, and vomiting. (6.1)
`
`To report SUSPECTED ADVERSE REACTIONS, contact Pfizer Inc at
`1-800-438-1985 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
`
`------------------------------DRUG INTERACTIONS------------------------------­
`• Other smoking cessation therapies: Safety and efficacy in combination
`with other smoking cessation therapies has not been established.
`Coadministration of varenicline and transdermal nicotine resulted in a high
`rate of discontinuation due to adverse events. (7.1)
`• Effect of smoking cessation: Pharmacokinetics or pharmacodynamics of
`certain drugs may be altered due to s moking cessation with CHANTIX,
`necessitating dose adjustment. (7.2)
`
`
`-----------------------USE IN SPECIFIC POPULATIONS-----------------------­
`• Pregnancy: CHANTIX should be used during pregnancy only if the
`potential benefit justifies the potential risk to the fetus. (8.1)
`• Nursing Mothers: Discontinue drug or nursing taking into consideration
`importance of drug to mother (8.3)
`• Pediatric Use: Safety and effectiveness not established (8.4)
`• Renal Impairment: Dosage adjustment is required for severe renal
`impairment. (2.2, 8.6)
`
`
`See 17 for PATIENT COUNSELING INFORMATION and Medication
`Guide
`
`
`---------------------DOSAGE FORMS AND STRENGTHS---------------------­
`Tablets: 0.5 mg and 1 mg (3)
`
`-------------------------------CONTRAINDICATIONS-----------------------------­
`History of serious hypersensitivity or skin reactions to CHANTIX (4)
`_______________________________________________________________________________________________________________________________________
`
`
`
`
`
`
`
`
`
`
`Revised: 12/2012
`
`FULL PRESCRIBING INFORMATION: CONTENTS*
`
`WARNING: SERIOUS NEUROPSYCHIATRIC EVENTS
`INDICATIONS AND USAGE
`1
`2 DOSAGE AND ADMINISTRATION
`2.1 Usual Dosage for Adults
`2.2 Dosage in Special Populations
`3 DOSAGE FORMS AND STRENGTHS
`4 CONTRAINDICATIONS
`5 WARNINGS AND PRECAUTIONS
`5.1 Neuropsychiatric Symptoms and Suicidality
`5.2 Angioedema and Hypersensitivity Reactions
`5.3 Serious Skin Reactions
`5.4 Cardiovascular Events
`5.5 Accidental Injury
`5.6 Nausea
` 6 ADVERSE REACTIONS
`
`
`
`6.1 Clinical Trials Experience
`
`
`
`
`6.2 Postmarketing Experience
`
`7 DRUG INTERACTIONS
`
`
`
`
`
`7.1 Use With Other Drugs for Smoking Cessation
`
`
`
`
`7.2 Effect of Smoking Cessation on Other Drugs
`Reference ID: 3228878
`
`8 USE IN SPECIFIC POPULATIONS
`8.1 Pregnancy
`8.3 Nursing Mothers
`8.4 Pediatric Use
`8.5 Geriatric Use
`8.6 Renal Impairment
`9 DRUG ABUSE AND DEPENDENCE
`9.1 Controlled Substance
`9.3 Dependence
`10 OVERDOSAGE
`11 DESCRIPTION
`12 CLINICAL PHARMACOLOGY
`12.1 Mechanism of Action
`12.3 Pharmacokinetics
`13 NONCLINICAL TOXICOLOGY
`13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
`
`14 CLINICAL STUDIES
`
`14.1 Initiation of Abstinence
`
`14.2 Urge to Smoke
`
`14.3 Long-Term Abstinence
`
`14.4 Subjects with Cardiovascular and Chronic Obstructive Pulmonary
`
`
`
`Disease
`
`14.5 Alternative Instructions for Setting a Quit Date
`
`
`
`
`

`

`17.8 History of Psychiatric Illness
`
`16 HOW SUPPLIED/STORAGE AND HANDLING
`17.9 Nicotine Withdrawal
`17 PATIENT COUNSELING INFORMATION
`17.10 Angioedema
`17.11 Serious Skin Reactions
`Medication Guide
`17.12 Patients with Cardiovascular Disease
`17.1 Initiate Treatment and Continue to Attempt to Quit if Lapse
`17.13 Driving or Operating Machinery
`17.2 How To Take
`17.14 Vivid, Unusual, or Strange Dreams
`17.3 Starting Week Dosage
`17.15 Pregnancy and Lactation
`17.4 Continuing Weeks Dosage
`
`17.5 Dosage Adjustment for CHANTIX or Other Drugs
`*Sections or subsections omitted from the full prescribing information are not
`17.6 Counseling and Support
`listed.
`17.7 Neuropsychiatric Symptoms
`_______________________________________________________________________________________________________________________________________
`
`
`FULL PRESCRIBING INFORMATION
`
`
`WARNING: SERIOUS NEUROPSYCHIATRIC EVENTS
`
`
`Serious neuropsychiatric events including, but not limited to,
`
`depression, suicidal ideation, suicide attempt, and completed suicide have
`been reported in patients taking CHANTIX. Some reported cases may have
`been complicated by the symptoms of nicotine withdrawal in patients who
`stopped smoking. Depressed mood may be a symptom of nicotine
`withdrawal. Depression, rarely including suicidal ideation, has been
`reported in smokers undergoing a smoking cessation attempt without
`medication. However, some of these symptoms have occurred in patients
`taking CHANTIX who continued to smoke.
`All patients being treated with CHANTIX should be observed
`for neuropsychiatric symptoms including changes in behavior, hostility,
`agitation, depressed mood, and suicide-related events, including ideation,
`behavior, and attempted suicide. These symptoms, as well as worsening of
`pre-existing psychiatric illness and completed suicide, have been reported
`in some patients attempting to quit smoking while taking CHANTIX in the
`postmarketing experience. When symptoms were reported, most were
`during CHANTIX treatment, but some were following discontinuation of
`CHANTIX therapy.
`These events have occurred in patients with and without pre­
`existing psychiatric disease. Patients with serious psychiatric illness such as
`schizophrenia, bipolar disorder, and major depressive disorder did not
`participate in the premarketing studies of CHANTIX, and the safety and
`efficacy of CHANTIX in such patients has not been established.
`Advise patients and caregivers that the patient should stop
`
`taking CHANTIX and contact a healthcare provider immediately if
`agitation, hostility, depressed mood, or changes in behavior or thinking
`that are not typical for the patient are observed, or if the patient develops
`suicidal ideation or suicidal behavior. In many postmarketing cases,
`resolution of symptoms after discontinuation of CHANTIX was reported,
`although in some cases the symptoms persisted; therefore, ongoing
`monitoring and supportive care should be provided until symptoms
`resolve.
`The risks of CHANTIX should be weighed against the benefits of
`
`its use. CHANTIX has been demonstrated to increase the likelihood of
`abstinence from smoking for as long as one year compared to treatment
`with placebo. The health benefits of quitting smoking are immediate and
`substantial. [see Warnings and Precautions (5.1) and Adverse Reactions
`6.2)]
`
`INDICATIONS AND USAGE
`1
`CHANTIX is indicated for use as an aid to smoking cessation treatment.
`
`2
`
`DOSAGE AND ADMINISTRATION
`2.1 Usual Dosage for Adults
`Smoking cessation therapies are more likely to succeed for patients who
`are motivated to stop smoking and who are provided additional advice and
`support. Provide patients with appropriate educational materials and counseling
`to support the quit attempt.
`The patient should set a date to stop smoking. Begin CHANTIX dosing
`one week before this date. Alternatively, the patient can begin CHANTIX
`dosing a nd then quit smoking between days 8 and 35 of treatment.
`CHANTIX should be taken after eating and with a full glass of water.
`The recommended dose of CHANTIX is 1 mg twice daily following a 1­
`week titration as follows:
`
`
`Days 1 – 3:
`Days 4 – 7:
`Day 8 – end of treatment:
`
`0.5 mg once daily
`0.5 mg twice daily
`1 mg twice daily
`
`
`
`Reference ID: 3228878
`
`3
`
`4
`
`Patients should be treated with CHANTIX for 12 weeks. For patients who
`have successfully stopped smoking at the end of 12 weeks, an additional course
`of 12 weeks’ treatment with CHANTIX is recommended to further increase the
`likelihood of long-term abstinence.
`Patients who do not succeed in stopping smoking during 12 weeks of
`initial therapy, or who relapse after treatment, should be encouraged to make
`another attempt once factors contributing to the failed attempt have been
`identified and addressed.
`Consider a temporary or permanent dose reduction in patients who cannot
`tolerate the adverse effects of CHANTIX.
`
`2.2 Dosage in Special Populations
`Patients with Impaired Renal Function: No dosage adjustment is
`necessary for patients with mild to moderate renal impairment. For patients
`with severe renal impairment (estimated creatinine clearance <30 mL/min), the
`recommended starting dose of CHANTIX is 0.5 mg once daily. The dose may
`then be titrated as needed to a maximum dose of 0.5 mg twice a day. For
`patients with e nd-stage renal disease undergoing hemodialysis, a maximum
`dose of 0.5 mg once daily may be administered if tolerated [see Use in Specific
`Populations (8.6) and Clinical Pharmacology (12.3)].
`Elderly and Patients with Impaired Hepatic Function: No dosage
`adjustment is necessary for patients with hepatic impairment. Because elderly
`patients are more likely to have decreased renal function, care should be taken
`in dose selection, and it may be useful to monitor renal function [see Use in
`Specific Populations (8.5)].
`
`DOSAGE FORMS AND STRENGTHS
`Capsular, biconvex tablets: 0.5 mg (white to off-white, debossed with
`"Pfizer" on one side and "CHX 0.5" on the other side) and 1 mg (light blue,
`debossed with "Pfizer" on one side and "CHX 1.0" on the other side)
`
`CONTRAINDICATIONS
`CHANTIX is contraindicated in patients with a known history of serious
`hypersensitivity reactions or skin reactions to CHANTIX
`
`5 WARNINGS AND PRECAUTIONS
`5.1 Neuropsychiatric Symptoms and Suicidality
`Serious neuropsychiatric symptoms have been reported in patients being
`treated with CHANTIX [see Boxed Warning and Adverse Reactions (6.2)].
`These postmarketing reports have included changes in mood (including
`depression and mania), psychosis, hallucinations, paranoia, delusions, homicidal
`ideation, hostility, agitation, anxiety, and panic, as well as suicidal ideation,
`suicide attempt, and completed suicide. Some reported cases may have been
`complicated by the symptoms of nicotine withdrawal in patients who stopped
`e a symptom of nicotine withdrawal.
`smoking. Depressed mood may b
`Depression, rarely including suicidal ideation, has been reported in smokers
`undergoing a smoking cessation attempt without medication. However, some of
`these symptoms have occurred in patients taking CHANTIX who continued to
`smoke. When symptoms were reported, most were during CHANTIX
`treatment, but some were following discontinuation of CHANTIX therapy.
`These events have occurred in patients with and without pre-existing
`psychiatric disease; some patients have experienced worsening of their
`psychiatric illnesses. All patients being treated with CHANTIX should be
`observed for neuropsychiatric symptoms or worsening of pre-existing
`psychiatric
`illness.
` Patients with serious psychiatric
`illness such as
`schizophrenia, bipolar disorder, and major depressive disorder did not
`participate in the premarketing studies of CHANTIX, and the safety and
`efficacy of CHANTIX in such patients has not been established.
`Advise patients and caregivers that the patient should stop taking
`CHANTIX and contact a healthcare provider immediately if agitation,
`depressed mood, changes in behavior or thinking that are not typical for the
`patient are observed, or if the patient develops suicidal ideation or suicidal
`behavior. In many postmarketing cases, resolution of symptoms after
`discontinuation of CHANTIX was reported, although in some cases the
`
`

`

`symptoms persisted, therefore, ongoing monitoring and supportive care should
`
`
`be provided until symptoms resolve.
`
`The risks of CHANTIX should be weighed against the benefits of its use.
`
`
`
`
`
`
`
`
`
`
`
`CHANTIX has been demonstrated to increase the likelihood of abstinence from
`
`
`
`
`
`
`smoking for as long as one year compared to treatment with placebo. The
`
`
`
`
`health benefits of quitting smoking are immediate and substantial.
`
`
`
`
`5.2 Angioedema and Hypersensitivity Reactions
`
`
`There have been postmarketing reports of hypersensitivity reactions
`
`including angioedema in patients treated with CHANTIX [see Adverse
`
`
`
`
`Reactions (6.2), and Patient Counseling Information (17.10)]. Clinical signs
`
`
`
`included swelling of the face, mouth (tongue, lips, and gums), extremities, and
`
`
`
`neck (throat and larynx). There were infrequent reports of life-threatening
`
`
`requiring emergent medical attention due
`respiratory
`angioedema
`to
`
`
`compromise. Instruct patients to discontinue CHANTIX and immediately seek
`
`
`
`medical care if they experience these symptoms.
`
`
`
`
`5.3 Serious Skin Reactions
`
`
`There have been postmarketing reports of rare but serious skin reactions,
`including Stevens-Johnson Syndrome and erythema multiforme, in patients
`
`
`
`
`
`using CHANTIX [see Adverse Reactions (6.2)]. As these skin reactions can be
`
`
`life-threatening, instruct patients to stop taking CHANTIX and contact a
`
`
`
`healthcare provider immediately at the first appearance of a skin rash with
`
`mucosal lesions or any other signs of hypersensitivity.
`
`
`
`5.4 Cardiovascular Events
`
`
`In a placebo-controlled clinical trial of CHANTIX administered to patients
`
`
`
`
`with stable cardiovascular disease, with approximately 350 patients per
`
`
`
`
`
`treatment arm, all-cause and cardiovascular mortality was lower in patients
`
`
`
`treated with CHANTIX, but certain nonfatal cardiovascular events occurred
`
`
`
`
`
`
`more frequently in patients treated with CHANTIX than in patients treated with
`
`
`
`
`
`
`placebo [see Clinical Trials Experience (6.1)]. Table 1 below shows the
`
`
`incidence of deaths and of selected nonfatal serious cardiovascular events
`
`
`
`
`occurring more frequently in the CHANTIX arm compared to the placebo arm.
`
`
`
`These events were adjudicated by an independent blinded committee. Nonfatal
`
`
`
`
`
`
`serious cardiovascular events not listed occurred at the same incidence or more
`
`
`
`
`commonly in the placebo arm. Patients with more than one cardiovascular event
`
`
`
`
`of the same type are counted only once per row. Some of the patients requiring
`
`
`coronary revascularization underwent the procedure as part of management of
`
`
`
`
`nonfatal MI and hospitalization for angina.
`
`
`
`Table 1. Mortality and Adjudicated Nonfatal Serious Cardiovascular
`
`
`
`Events in the Placebo-Controlled CHANTIX Trial in Patients with Stable
`
`
`Cardiovascular Disease
`
`
`
` CHANTIX
`
` (N=353)
`
` n (%)
`
`
` Placebo
`
` (N=350)
`
` n (%)
`
`
`
` Mortality and Cardiovascular Events
`
`
`
`
` Mortality (Cardiovascular & All-cause up to 52 wks)
` Cardiovascular death
`
`
` All-cause mortality
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
` 1 (0.3)
`
` 2 (0.6)
`
`
`
` 5 (1.4)
`
`
` 2 (0.6)
`
` 5 (1.4)
`
`
`
` 1 (0.3)
`
` 0 (0)
`
`
` 2 (0.6)
`
` 2 (0.6)
`
` 4 (1.1)
`
` 0 (0)
`
`
`
` 2 (0.6)
`
`
`
`
` Nonfatal Cardiovascular Events (rate on CHANTIX > Placebo)
` Up to 30 days after treatment
`
`
`
`
`
`
` Nonfatal myocardial infarction
` 4 (1.1)
`
` 2 (0.6)
` Nonfatal Stroke
`
`
` Beyond 30 days after treatment & up
`
`
` to 52 weeks
`
` Nonfatal myocardial infarction
` 3 (0.8)
`
` Need for coronary
`
` 7 (2.0)
`
` revascularization
`
`
` Hospitalization for angina pectoris
`
` 6 (1.7)
`
` Transient ischemia attack
`
` 1 (0.3)
` New diagnosis of peripheral
`
`vascular disease (PVD) or
`
` admission for a PVD procedure
`
`
`
` A meta-analysis of 15 clinical trials of ≥ 12 weeks treatment duration,
`
`
`
`
`including 7002 patients (4190 CHANTIX, 2812 placebo), was conducted to
`
`
`
`systematically assess the cardiovascular safety of CHANTIX. The study in
`
`
`patients with stable cardiovascular disease described above was included in the
`
`
`
`meta-analysis. There were lower rates of all-cause mortality (CHANTIX 6
`
`
`
`[0.14%]; placebo 7 [0.25%]) and cardiovascular mortality (CHANTIX 2
`
`
`
`
`[0.05%]; placebo 2 [0.07%]) in the CHANTIX arms compared with the placebo
`
`
`
`
`arms in the meta-analysis.
`
`
`The key cardiovascular safety analysis included occurrence and timing of
`
`
`
`
`
`
`a composite endpoint of Major Adverse Cardiovascular Events (MACE),
`
`
`defined as cardiovascular death, nonfatal MI, and nonfatal stroke. These events
`
`
`
`Reference ID: 3228878
`
` included in the endpoint were adjudicated by a blinded, independent committee.
`
`
`
`
`Overall, a small number of MACE occurred in the trials included in the meta­
`
`
`
`analysis, as described in Table 2. These events occurred primarily in patients
`
`
`
`
`with known cardiovascular disease.
`
`
`
`Table 2. Number of MACE cases, Hazard Ratio and Rate Difference in a
`
`
`
`
`
`
`
`Meta-Analysis of 15 Clinical Trials Comparing CHANTIX to Placebo*
`
`
`
`
`
`
`
`
`
`
`
` CHANTIX
`
` N=4190
` 13 (0.31%)
`
`
`
`
` 1316
`
`
`
` MACE cases, n (%)
`
`
`Patient-years of
`
` exposure
`
` Hazard Ratio (95% CI)
` 1.95 (0.79, 4.82)
`
`
`
`
` Rate Difference per 1,000 patient-years (95% CI)
`
`
` 6.30 (-2.40, 15.10)
`
` *Includes MACE occurring up to 30 days post treatment.
`
`
`
`
`
`
`
`
`
`
` Placebo
`
` N=2812
` 6 (0.21%)
`
`
`
`
`
` 839
`
`
`
`
`
`
`The meta-analysis showed that exposure to CHANTIX resulted in a
`
`
`
`hazard ratio for MACE of 1.95 (95% confidence interval from 0.79 to 4.82) for
`patients up to 30 days after treatment; this is equivalent to an estimated increase
`
`
`
`
`
`of 6.3 MACE events per 1,000 patient-years of exposure. The meta-analysis
`
`
`showed higher rates of CV endpoints in patients on CHANTIX relative to
`
`
`
`
`
`placebo across different time frames and pre-specified sensitivity analyses,
`
`
`
`
`including various study groupings and CV outcomes. Although these findings
`
`
`were not statistically significant they were consistent. Because the number of
`
`
`
`
`events was small overall, the power for finding a statistically significant
`difference in a signal of this magnitude is low.
`
`CHANTIX was not studied in patients with unstable cardiovascular
`
`
`
`
`disease or cardiovascular events occurring within two months before screening.
`
`
`Patients should be advised to notify a health care provider of new or worsening
`
`
`
`
`
`symptoms of cardiovascular disease. The risks of CHANTIX should be weighed
`
`
`against the benefits of its use in smokers with cardiovascular disease. Smoking
`
`
`
`
`
`
`is an independent and major risk factor for cardiovascular disease. CHANTIX
`
`
`
`
`has been demonstrated to increase the likelihood of abstinence from smoking
`
`
`
`
`for as long as one year compared to treatment with placebo.
`
`
`
`
`5.5 Accidental Injury
`
`
`There have been postmarketing reports of traffic accidents, near-miss
`
`incidents in traffic, or other accidental injuries in patients taking CHANTIX. In
`
`
`
`
`
`some cases, the patients reported somnolence, dizziness, loss of consciousness
`
`or difficulty concentrating that resulted in impairment, or concern about
`
`
`potential impairment, in driving or operating machinery. Advise patients to use
`
`
`
`
`caution driving or operating machinery or engaging in other potentially
`
`
`hazardous activities until they know how CHANTIX may affect them.
`
`
`5.6 Nausea
`
`
`Nausea was the most common adverse reaction reported with CHANTIX
`
`
`
`
`
`treatment. Nausea was generally described as mild or moderate and often
`
`
`transient; however, for some patients, it was persistent over several months. The
`
`
`incidence of nausea was dose-dependent. Initial dose-titration was beneficial in
`
`reducing the occurrence of nausea. For patients treated to the maximum
`
`
`recommended dose of 1 mg twice daily following initial dosage titration, the
`
`
`
`incidence of nausea was 30% compared with 10% in patients taking a
`
`
`
`comparable placebo regimen. In patients taking CHANTIX 0.5 mg twice daily
`
`
`
`
`following initial titration, the incidence was 16% compared with 11% for
`
`
`
`placebo. Approximately 3% of patients treated with CHANTIX 1 mg twice
`
`
`
`
`
`daily in studies involving 12 weeks of treatment discontinued treatment
`
`prematurely because of nausea. For patients with intolerable nausea, a dose
`
`
`reduction should be considered.
`
`
`
`ADVERSE REACTIONS
`
`The following serious adverse reactions were reported in postmarketing
`
`experience and are discussed in greater detail in other sections of the labeling:
`
`
`
`
`•
`
`
`6
`
`
`Neuropsychiatric symptoms and suicidality [see Boxed Warning and
`
`
`
`
`Warnings and Precautions (5.1)
`
`
`Angioedema and hypersensitivity reactions [see Warnings and
`
`
`Precautions (5.2)]
`
`Serious skin reactions [see Warnings and Precautions (5.3)]
`
`
`
`
`Accidental injury [see Warnings and Precautions (5.5)]
`
`
`
`
`
`•
`
`
`•
`
`•
`
`
`
`In the placebo-controlled studies, the most common adverse events
`
`
`
`associated with CHANTIX (>5% and twice the rate seen in placebo-treated
`
`
`
`
`

`

`
` 6.1 Clinical Trials Experience
`
`
`
`
`
`
` Because clinical trials are conducted under widely varying conditions, the
`
`
`
`
` adverse reactions rates observed in the clinical studies of a drug cannot be
`
` directly compared to rates in the clinical trials of another drug and may not
` reflect the rates observed in clinical practice.
`
`
`
`
` During the premarketing development of CHANTIX, over 4500 subjects
`
` were exposed to CHANTIX, with over 450 treated for at least 24 weeks and
`
` approximately 100 for a year. Most study participants were treated for 12 weeks
`
`
` or less.
`
`
` The most common adverse event associated with CHANTIX treatment is
`
` nausea, occurring in 30% of patients treated at the recommended dose,
`
`
` compared with 10% in patients taking a comparable placebo regimen [see
`
`
`
`
`
`
`
`
`
`
`
` Warnings and Precautions (5.6)].
`
`
`
` Table 3 shows the adverse events for CHANTIX and placebo in the 12­
`
`
`
`
` week fixed dose studies with titration in the first week [Studies 2 (titrated arm
`
`
` only), 4, and 5]. Adverse events were categorized using the Medical Dictionary
`
`
`
`
`
`
`
` for Regulatory Activities (MedDRA, Version 7.1).
`
`
`
`
`
`
`
` MedDRA High Level Group Terms (HLGT) reported in ≥ 5% of patients
`
`
` in the CHANTIX 1 mg twice daily dose group, and more commonly than in the
`
`
`
`
` placebo group, are listed, along with subordinate Preferred Terms (PT) reported
`
`
`
` in ≥ 1% of CHANTIX patients (and at least 0.5% more frequent than placebo).
`
`
`
`
`
`
`
`
`
`
`
`
`
`
` Closely related Preferred Terms such as ‘Insomnia’, ‘Initial insomnia’, ‘Middle
`
`
`
`
`
`
`
`
` insomnia’, ‘Early morning awakening’ were grouped, but individual patients
`
`
` reporting two or more grouped events are only counted once.
`
`
`
`
` Table 3: Common Treatment Emergent AEs (%) in the Fixed-Dose,
` Placebo-Controlled Studies (HLGTs > 5% of patients in the 1 mg BID
`
`
`
`
`
`
`CHANTIX Group and more commonly than placebo and PT ≥ 1% in the 1
`
`
`
`
`
`
`mg BID CHANTIX Group, and 1 mg BID CHANTIX at least 0.5% more
`
`
`
`
`than Placebo)
`
`
`
` CHANTIX
`
` 0.5 mg BID
`
` N=129
`
`
`
` 16
` 5
`
`
` 9
`
` 5
`
` 1
`
`
`
`
`
`
`
`
`
`
`
`
` 4
`
`
`
`
` 0
`
` 2
`
` 7
`
`
`
`
`
`
` 1
`
` 0
`
`
`
`
`
` 4
`
` 1
`
`
`
` 7
`
`
`
`
` 1
`
` 1
`
` 5
`
`
`
`
`
`
` 3
`
` 1
`
`
`
`
`
` 3
`
` 2
`
`
`
` 6
`
`
`
`
` 0
`
` 1
`
` 4
`
`
`
`
`
`
` 2
`
` 1
`
`
`
`
`
` 2
`
` 1
`
` General Disorders NEC
`
`
` Fatigue/Malaise/Asthenia
`
`
`RESPIR/THORACIC/MEDI
`
` AST
` Respiratory Disorders NEC
`
`
`
` Rhinorrhea
`
`
` Dyspnea
`
` Upper Respiratory Tract
`
`
` Disorder
` SKIN/SUBCUTANEOUS
`
` TISSUE
`
` Epidermal and Dermal
`
`
` Conditions
`
`
`
` Rash
`
`
` Pruritis
`
` METABOLISM &
`
` NUTRITION
` Appetite/General Nutrit.
`
`
`
` Disorders
` Increased appetite
`
`
`
`
` Decreased appetite/
`
`
` Anorexia
`
`
`
`
`
`* Includes PTs Abdominal (pain, pain upper, pain lower, discomfort,
`
`
`
`tenderness, distension) and Stomach discomfort
`
`
`
`
`** Includes PTs Insomnia/Initial insomnia/Middle insomnia/Early morning
`
`awakening
`
`
`
`
`
`The overall pattern and frequency of adverse events during the longer-
`
`
`
`
`
`term trials was similar to those described in Table 3, though several of the most
`
`
`common events were reported by a greater proportion of patients with long-term
`
`
`
`
`
`
`
`
`
`
`
`
`use (e.g., nausea was reported in 40% of patients treated with CHANTIX 1 mg
`
`
`
`twice daily in a one-year study, compared to 8% of placebo-treated patients).
`
`Following is a list of treatment-emergent adverse events reported by
`
`patients treated with CHANTIX during all clinical trials. The listing does not
`
`include those events already listed in the previous tables or elsewhere in
`
`
`labeling, those events for which a drug cause was remote, those events which
`
`
`
`
`were so general as to be uninformative, and those events reported only once
`
`
`
`which did not have a substantial probability of being acutely life-threatening.
`
`Infrequent:
`
`Blood
`and Lymphatic System Disorders.
`anemia,
`lymphadenopathy. Rare: leukocytosis, splenomegaly, thrombocytopenia.
`
`
`
`Cardiac Disorders. Infrequent: angina pectoris, arrhythmia, bradycardia,
`
`
`
`myocardial infarction, palpitations, tachycardia, ventricular extrasystoles. Rare:
`
`
`
`
`acute coronary syndrome, atrial fibrillation, cardiac flutter, cor pulmonale,
`
`
`coronary artery disease.
`
`Ear and Labyrinth Disorders. Infrequent: tinnitus, vertigo. Rare: deafness,
`
`
`
`Meniere’s disease.
`
`Endocrine Disorders. Infrequent: thyroid gland disorders.
`
`
`Eye Disorders. Infrequent: conjunctivitis, dry eye, eye irritation, eye pain,
`
`
`
`
`
`
`vision blurred, visual disturbance. Rare: acquired night blindness, blindness
`
`
`
`
`transient, cataract subcapsular, ocular vascular disorder, photophobia, vitreous
`
`
`floaters.
`
`Gastrointestinal Disorders. Frequent: diarrhea. Infrequent: dysphagia,
`
`
`
`
`enterocolitis, eructation, esophagitis, gastritis, gastrointestinal hemorrhage,
`
`
`
`
`mouth ulceration. Rare: gastric ulcer, intestinal obstruction, pancreatitis acute.
`
`
`
`General Disorders and Administration Site Conditions. Frequent: chest
`
`
`
`pain, edema, influenza-like illness. Infrequent: chest discomfort, chills, pyrexia.
`
`
`
`
`
`Hepatobiliary Disorders. Infrequent: gall bladder disorder.
`
`
`Investigations. Frequent: liver function test abnormal, weight increased.
`
`
`Infrequent: electrocardiogram abnormal, muscle enzyme increased, urine
`
`
`analysis abnormal.
`
`Metabolism and Nutrition Disorders. Infrequent: diabetes mellitus,
`
`
`hyperlipidemia, hypokalemia. Rare: hypoglycemia.
`
`
`
`Musculoskeletal and Connective Tissue Disorders. Frequent: arthralgia,
`
`
`
`
`back pain, muscle cramp, musculoskeletal pain, myalgia. Infrequent: arthritis,
`
`
`
`osteoporosis. Rare: myositis.
`
`
`
`Nervous System Disorders. Frequent: disturbance in attention, dizziness,
`
`
`
`
`
`sensory disturbance. Infrequent: amnesia, migraine, parosmia, psychomotor
`
`
`
`hyperactivity, restless legs syndrome, syncope, tremor. Rare: balance disorder,
`
`
`cerebrovascular accident, convulsion, dysarthria,
`facial palsy, mental
`
`
`impairment, multiple sclerosis, nystagmus, psychomotor skills impaired,
`
`
`
`transient ischemic attack, visual field defect.
`
`
`
`
`Psychiatric Disorders. Infrequent: disorientation, dissociation, libido
`
`
`
`decreased, mood swings, thinking abnormal. Rare: bradyphrenia, euphoric
`
`
`
`
`mood.
`
`
`
`
`
`
` patients) were nausea, abnormal (vivid, unusual, or strange) dreams,
` constipation, flatulence, and vomiting.
`
`
`
`
`
`
` The treatment discontinuation rate due to adverse events in patients dosed