The Pharmaceutical Journal
Vol 279 No 7476 p490
3 November 2007

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Varenicline to be issued by PGD in City and Hackney

Pharmacists in the east of London are to provide the smoking cessation medicine varenicline (Champix) under a new patient group direction (PGD) through City and Hackney Teaching Primary Care Trust.

The scheme, training for which started this week, involves supplying the medicine under the PGD to dependent smokers who have tried nicotine replacement therapy (NRT) in the past and have not found it useful, or to smokers who have approached the pharmacist asking to receive varenicline.

Jonathan Mason, head of prescribing and pharmacy at the PCT, told The Journal that there was already a well established stop smoking enhanced service in place, which included a PGD for NRT. He explained that when varenicline was first launched the PCT issued guidance for GPs on prescribing the drug, which allowed for two-week supplies to be given.

Anecdotal reports from pharmacists alerted the PCT to the fact that some GPs were prescribing greater quantities and not always giving the appropriate behavioural support suggested by the manufacturer.

The PCT believed that the best way to ensure the right support was given was to develop a PGD through community pharmacy, said Mr Mason. “Pharmacists were also being approached by people who had tried NRT and failed to quit, coming into the pharmacy and saying ‘can I have this new drug’,” he added.

As with the PCT’s existing NRT arrangement, pharmacists are paid to provide level 2 stop smoking advice as part of the enhanced pharmacy service, and the pharmacist is also reimbursed the NHS price for varenicline by the PCT’s public health directorate.

Mr Mason explained that patients first receive a two-week initiation pack of varenicline, which facilitates a stepwise increase of the dose. The patient then has to come back regularly, every two weeks, for support and monitoring, and to receive maintenance supplies for a period of up to 12 weeks.

The PCT allows patients who have not managed to quit fully until late in the course to be supplied varenicline for a further three months.