Before Proceeding to the  CHANTIX  Medial Consultation Form please read
CONTRAINDICATIONS and WARNINGS
and accept the Waiver of Liability
In order for Medical Wellness Center Physicians to provide you with the best care you need to reply honesty to all questions and you need to understand any and all risks and side effects associated with CHANTIX.
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CONTRAINDICATIONS:
Chantix  is the first new anti-smoking prescription pill approved by the FDA in the last decade .  CHANTIX use is CONTRAINDICATED and must NOT be used in anyone with the following conditions: 
  • Anyone with any kidney disease, renal impairment, kidney transplant or on DIALYSIS or has any other medical disorder of kidney function should not take Chantix as it is eliminated from the body via the kidneys.  If you have any questions about your medical condition, consult your primary care physician before taking Chantix.
  • Do NOT Chantix if you are pregnant or breast feeding.  It can possibly have effects on the fetus or baby.
  • Do NOT take Chantix if you are allergic to the active ingredient: varenicline or any of the inactive ingredients: microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, colloidal silicon dioxide, and magnesium
  • Do NOT take  Chantix if you are on INSULIN, ASTHMA MEDICATIONS OR BLOOD THINNERS (warfarin, coumadin etc.) Do NOT take Chantix unless your personal physician prescribes it and is directly monitoring you. SMOKING CESSATION can have significant effects on the effectiveness of INSULIN, ASTHMATIC MEDICATIONS, and BLOOD THINNERS (coumadin, warfarin etc)  Not abiding by these guidelines can result in serious and even fatal consequences.
  • Do NOT combine Chantix with Zyban or other stop smoking medications or treatments including over the counter nicotine patches.  There has been evidence of more severe side effects when combining therapies.
  • Do NOT take Chantix if you are under the age of 18.
IMPORTANT WARNINGS/ PRECAUTION:
Although there are no known drug interactions with Chantix, not all possible drug-drug interactions have been studies. Do NOT combine Chantix with other forms of smoking cessation medications whether over the counter or prescription.  Do NOT combine with Zyban or nicotine patches etc.  Side effects could be potentiated.

Keep Chantix and all medications away from children
 
 

CHANTIX SIDE EFFECTS:

Chantix is generally well tolerated.  Nausea is the most common side effect experienced initially by about 30% of patients.  Please note; With or without treatment, you most likely will experience some nicotine withdrawal symptoms associated with quitting smoking.  Chantix helps mitigate nicotine withdrawal.

Other side effects: 

  • Gastrointestinal  - abdominal pain, flatulence, vomiting, constipation, dry mouth, changes in taste perception
  • Psychiatric - insomnia, changes in dreaming, nightmares
  • Nervous system - headache, fatigue, lethargy
  • Dermatological - skin problems, rashes
  • Rare side effects:
        respiratory, cardiac disorders, blood and lymphatic disorders
     

    Stop taking Chantix  and seek emergency medical attention if you experience an allergic reaction such as difficulty breathing, closing of the throat, swelling of the lips, tongue or face. 
     
     

    IMPORTANT INFORMATION:

    Smoking is a difficult nicotine addiction to break.  It often takes numerous attempts of quitting smoking before you are successful.  Chantix has a high success rate in motivated quitters.  Often during the initial 12 week treatment regimen, you can have lapses.  Don't get discouraged, continue to attempt to quit smoking.

    Pfizer provides a free patient support program designed to help address behavioral components of smoking dependence. 
     

    I DO NOT HAVE ANY OF THE ABOVE CONTRAINDICATIONS:
    By accepting "I Agree" means that you have read the above contraindication and warnings and honestly acknowledge that you do not have any of the above contraindications to Chantix therapy. Also, that I am aware that if I have any questions about taking Chantix I need to consult with personal primary care doctor .
    I agree, proceed to Waiver of LiabilityI disagree

     
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