[On oral medications, especially varenicline].

Varenicline is an orally administered alpha4beta2 nicotinic acetylcholine receptor partial agonist. It has been widely used in smoking cessation therapy. It reduces craving and withdrawal symptoms during abstinence and lowers the reinforcing effects of nicotine. A third action of the drug is to blunt responses to smoking cues. Varenicline has higher abstinence rates than nicotine transdermal patches or bupropion. As serious neuro-psychiatric symptoms had been reported post market, including drowsiness, suicidal thoughts and suicide, clinicians are recommended to review the patient's psychiatric history and should monitor them for changes in mood and behavior when prescribing this medication. Studies on flexible dosing regimens, flexible quit dates, and an increased pre-quit medication period have indicated possible improvement to varenicline's effectiveness.