1. Supply Varenicline Under PGD
Formby Hall Golf Club
July 6th 2011

2. Agenda Introduction Service Out Line An Overview of Varenicline
Varenicline Patient Group Direction
Administration

3. Aim of Service
Establish a network of community pharmacies that can supply varenicline under PGD to clients of SSSS on the day of referral.

4. Service Outline Client consultation with SSSS
Champix preferred option for client
Referral letter
GP Prescribes
NRT Voucher
Client returns to SSSS at appropriate intervals
2 weeks NRT if Champix not appropriate
Champix – 2 weeks supply
Pharmacy dispenses required item

5. Service Outline Client consultation with SSSS
Champix preferred option for client
Referral letter
Pharmacy PGD
Refer to GP if not appropriate
2 weeks Champix
Inform GP Champix supplies to client
Client returns to SSSS at appropriate intervals

6. Patient Group Direction
better health for better life
Varenicline
Patient Group Direction
NHS SEFTON PRESENTATION TEMPLATE – the vertical ribbons and the coastal bar at the bottom must be used in this position, but are optional. Please try to use all elements, but the vertical ribbons can be removed if space is at a premium. The Strapline ‘better health’ must be used as an absolute minimum.

7. Patient Group direction
‘a written instruction for the supply and/or administration of a licensed medicine (or medicines) in an identified clinical situation, signed by a doctor or dentist and a pharmacist. It applies to groups of patients who may not be individually identified before presenting for treatment.’

8. In this case Medicine Clinical situation Patient Group
Varenicline (Champix®)
Clinical situation
Community pharmacy
Patient Group
Smokers motivated to quit

9. Inclusion Criteria
Tobacco users identified as sufficiently motivated to quit (determined by SSSS)
Aged 18 or over
Valid consent obtained

10. Exclusion Criteria Clients under the age of 18 years
Clients with a history of psychiatric illness including depression
Pregnancy and breast feeding
Hypersensitivity to the active substance or to any of the excipients
Renal impairment
End stage renal disease
No valid consent

11. Action if excluded Refer to GP using referral letter from SSSS
Annotate to indicate the client is not suitable for supply under PGD

12. Advice to client
Clients should be advised to set a quit date 7 to 14 days after initiation
Major reasons for failure are: - Unrealistic expectations; - Lack of preparation for the fact that the tablets may cause nausea; - Insufficient or incorrect use.

13. Advice to client
It is important to make sure that the client understands the following points:
Varenicline is not a magic cure: effort and determination are crucial;
It works by acting on the parts of the brain which are affected by nicotine in cigarettes;
It does not remove all temptation to smoke, but it does make abstinence easier (‘it takes the edge off the discomfort’)

14. Advice to client
It is important to make sure that the client understands the following points:
Varenicline is safe, but about a third of patients may experience mild nausea some 30 minutes after taking it. This reaction usually diminishes gradually over the first few weeks, and most patients tolerate it without problems
Instruct on correct use and daily dose.

15. Advice to client
At the end of treatment, discontinuation of varenicline has been associated with an increase in irritability, urge to smoke, depression, and/or insomnia in up to 3% of patients.

16. Administration All referral letters will carry a serial number
Serial number and client details to be entered into Servicepact®
Pharmacist asked to confirm
Inclusion criteria apply
Exclusion criteria do not apply

17. Administration Pharmacist asked to confirm
Advice given in relation to suicidal behaviour
Client advised of side effects
Client advised of cautions/additional information