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News Bulletin : ADA News Bulletin July 2011
Did you know that up to of smokers would try and quit on their dentists’ advice?1 38% In fact dental professionals are now recognised as having a significant role to play in smoking prevention; however, advising patients on quitting smoking may not be a routine part of clinical practice for many.2 As such Pfizer has developed a specific dental smoking cessation information pack to assist dentists in offering simple advice to their patients who smoke and a referral to their general practitioner for smoking cessation treatments if appropriate. CHAMPIX® (varenicline as tartrate) is a prescription-only, oral smoking cessation treatment from Pfizer.3 It is a non-nicotine treatment that acts in two ways;1 1) it partially stimulates the nicotine receptors in the brain, releasing a small amount of dopamine to alleviate the symptoms of craving and withdrawal,3–6 and 2) it simultaneously blocks the same nicotine receptors preventing the rewarding and reinforcing effects of smoking.3,4,6 A clinical study has shown that CHAMPIX® increases the odds of quitting at 1 year by almost 3-fold versus placebo alone (p<0001).7 Furthermore, when quitting with CHAMPIX®, patients report less cravings and urge to smoke, as well as less satisfaction and reward from smoking versus placebo,4,8–11 or NRT patches.12 In addition, nicotine withdrawal symptoms can also be relieved with CHAMPIX® therapy.3–5 The good news is that the Government subsidises a full 12-week course of CHAMPIX®, as well as an additional 12 weeks of CHAMPIX® for patients who are abstinent at the end of the initial 12 weeks of therapy13 to further increase their chances of success.14 So which patients could you consider referring? If a patient exhibits features of nicotine dependence,15 they could benefit from a referral to their GP. These behaviours include: Smoking soon after waking15 Smoking when ill15 Having difficulty refraining from smoking15 Reporting the first cigarette of the day to be the most difficult to give up15 Smoking more in the morning than the afternoon15 Australians are well aware of the general health risks associated with cigarette smoking, but may not be as aware of the dental impact. Therefore, dentists are in a unique position to counsel their patients on the substantial oral and general health benefits of quitting smoking, as well as referring them on to smoking cessation services.2 With the emerging information on patient acceptance of smoking cessation advice16 and the increasing evidence that tobacco use causes a number of oral health issues,2 dentists have a significant role in supporting patients to quit.2 For more information on CHAMPIX®, please contact Pfizer Medical Information on 1800 675 229. You can help Dental Patients Quit 6 Cases of neuropsychiatric symptoms such as depressed mood, agitation, aggression, hallucinations, anxiety, psychosis, mood swings, changes in behaviour or thinking, suicidal ideation and suicide have been reported during post-marketing experience with CHAMPIX®. The role of CHAMPIX® in these reports is not known. Patients on CHAMPIX® should be observed for neuropsychiatric symptoms and worsening of pre-existing psychiatric illness. Patients and their families should be advised to stop CHAMPIX® and see their doctor at the first sign of any of these symptoms. Ongoing follow-up should be provided until these symptoms resolve. Before prescriBing, please review full product information availaBle from pfizer australia pty ltd. CHAMPIX® (varenicline as tartrate) 0.5mg and 1mg tablets. INDICATIONS: aid to smoking cessation in adults (≥18 years). CONTRAINDICATIONS: Hypersensitivity to varenicline or excipients. PRECAUTIONS: neuropsychiatric symptoms: history of or underlying psychiatric illness; serious symptoms including changes in behaviour or thinking, anxiety, psychosis, mood swings, agitation, hallucinations, aggression, depressed mood, suicidal ideation and suicidal behaviour; patients and families to monitor; patients to stop taking cHampiX® at first sign of symptoms and contact a health care professional immediately; ongoing follow-up until resolution. not studied in serious psychiatric illness (schizophrenia, bipolar disorder, major depressive disorder) or epilepsy. post-marketing reports of rare but potentially fatal hypersensitivity reactions including angioedema, stevens-Johnson syndrome, erythema multiforme. theophylline, warfarin, insulin, cyp1a2 substrates, nicotine replacement therapy. driving or operating machinery. pregnancy, lactation. see full pi for details. ADVERSE EFFECTS: smoking cessation/nicotine withdrawal symptoms. most common: nausea, insomnia, abnormal dreams, headache, constipation, flatulence, dry mouth, dysgeusia, dizziness. post-marketing reports of myocardial infarction* and stroke*. see full pi for details. DOSAGE AND ADMINISTRATION: patients should set a date to quit smoking. dosing should start 1–2 weeks before this date. days 1–3: 0.5mg once daily. days 4–7: 0.5mg twice daily. day 8–end of 12 week treatment: 1mg twice daily. possible additional 12 week treatment at 1mg twice daily. dose tapering not required at end of treatment. patients with severe renal impairment: day 1–3: 0.5mg once daily. days 4–end of 12 week treatment: 1mg once daily. Based on tga approved product information dated 15 february 2007 and amended 10 december 2010. pBs dispensed price: initiation pack (53 tablets) $103.76; maintenance pack (1mg 112 tablets) $231.70; continuation pack (1mg 56 tablets) $120.42. *please note changes in product information. References: 1. afifah r, et al. Aust Dent J 2008;53(3):208–16. 2 . fdi / wHo (2005) tobacco or oral health: an advocacy guide for oral health professionals. edited Beaglehole rH and Benzian Hm; fdi world dental federation, ferney voltaire, france / world dental press, lowestoft, uK. 3. cHampiX® (varenicline tartrate) approved product information. pfizer australia pty ltd. 4. Jorenby de, et al. JAMA 2006;296:56–63. 5. coe Jw, et al. J Med Chem 2005;48:3474–7. 6. european public assessment report (epar). cHampiX: scientific discussion 2009. (available at: http://ww w.ema.europa.eu/docs/en_gB/document _library/epar_-_product _information/human/000699/wc500025251.pdf. 7. nides m, et al. Am J Health Behav 2008;32(6):664–75. 8 . nides m, et al. Arch Intern Med 2006;166:1561–8. 9. west r. psychopharmacology 2008;197:371–7. 10. Keating gm, et al. CNS Drugs 2006;20(11):945–60 . 11. gonzales dH et al. JAMA 2006;296:47–55 . 12. aubin HJ, et al. Thorax 2008;63:717–24. 13. pharmaceutical Benefits schedule, november 2010. 14. tonstad s, et al. JAMA 2006;296:64–71. 15. smoking cessation guidelines for australian general practice. practice Handbook, 2004. 16. coleman t, et al. Br J Gen Pract 1999;49:557–8 . pfizer australia pty limited aBn 50 008 422 348 www.pfizer.com.au pfizer medical information: 1800 675 229. p3595 03/11 ppu1048/ada. PBS Information: This product is authority listed on the PBS as an aid for smoking cessation for adults. Refer to PBS schedule for full information. Pfizer Australia Pty Limited 38–42 Wharf Road, West Ryde NSW 2114 AdveRTORIAl PPU1054_ADA Advertorial_04.indd 1-2 6/04/11 9:42 AM
ADA News Bulletin June 2011
ADA News Bulletin August 2011