ALCOAST 289/08
COMDTNOTE  6230
SUBJ: SMOKING CESSATION UPDATE, WARNING AGAINST USE OF CHANTIX
1.  ON 21 MAY 2008, THE INSTITUTE FOR SAFE MEDICATION PRACTICE
(ISMP) RELEASED A REPORT ON SIDE EFFECTS AND ADVERSE SAFETY
CONCERNS ASSOCIATED WITH CHANTIX (VARENICLINE). CHANTIX IS
INCREASINGLY USED ACROSS THE COUNTRY AND WITHIN DOD AND THE COAST
GUARD IN SMOKING CESSATION PROGRAMS.
2.  THE ISMP REPORT INCLUDES THE FOLLOWING - THERE ARE IMMEDIATE
SAFETY CONCERNS ABOUT THE USE OF CHANTIX AMONG PERSONS OPERATING
AIRCRAFT, TRAINS, BUSES AND OTHER VEHICLES, OR IN OTHER SETTINGS
WHERE A LAPSE IN ALERTNESS OR MOTOR CONTROL COULD LEAD TO MASSIVE,
SERIOUS INJURY. OTHER EXAMPLES INCLUDE PERSONS OPERATING NUCLEAR
POWER REACTORS, HIGH-RISE CONSTRUCTION CRANES OR LIFE-SUSTAINING
MEDICAL DEVICES. BASED ON REPORTS OF SUDDEN LOSS OF CONSCIOUSNESS,
SEIZURES, MUSCLE SPASMS, VISION DISTURBANCES, HALLUCINATIONS,
PARANOIA AND PSYCHOSIS, CHANTIX MAY NOT BE SAFE TO USE IN THESE
SETTINGS. THE EXTENT TO WHICH CHANTIX HAS ALREADY CONTRIBUTED TO
ACCIDENTAL DEATH AND INJURY HAS NOT YET BEEN INVESTIGATED BECAUSE
THESE ADVERSE EFFECTS HAD NOT BEEN PREVIOUSLY REPORTED.
3. THE SAFETY AND HEALTH OF OUR MEN AND WOMEN IN UNIFORM IS
PARAMOUNT. ASSISTING WITH THEIR DESIRE TO STOP SMOKING IS IMPORTANT
WHEREVER THEY ARE ASSIGNED AND WHATEVER THEIR MISSION IS. HOWEVER,
ENSURING THAT MEDICATIONS PRESCRIBED DO NOT PUT THEM AND OTHERS AT
INCREASED RISK OF INJURY OR DEATH IS ESSENTIAL.
4.  COAST GUARD PERSONNEL WHO ARE CURRENTLY TAKING CHANTIX ARE
STRONGLY ENCOURAGED TO STOP TAKING THE MEDICATION UNTIL FURTHER
GUIDANCE FROM CG-11, AND SHOULD DISCUSS WITH THEIR HEALTH CARE
PROVIDER APPROPRIATE TREATMENT ALTERNATIVES.
5.  COAST GUARD PERSONNEL TAKING OR DISCONTINUING USE OF CHANTIX
SHOULD IMMEDIATELY REPORT CHANGES IN MOOD AND BEHAVIOR TO THEIR
HEALTH CARE PROVIDER.  INDIVIDUALS TAKING CHANTIX MAY EXPERIENCE
VIVID, UNUSUAL, OR STRANGE DREAMS AND MAY EXPERIENCE IMPAIRMENT OF
THE ABILITY TO DRIVE OR OPERATE HEAVY MACHINERY. SYMPTOMS MAY
INCLUDE ANXIETY, NERVOUSNESS, TENSION, DEPRESSED MOOD, UNUSUAL
BEHAVIORS, AND THINKING ABOUT OR ATTEMPTING SUICIDE.
6. HEALTH CARE PROVIDERS AND COAST GUARD PERSONNEL SHALL BE ALERT
TO, AND MONITOR FOR, CHANGES IN MOOD AND BEHAVIOR IN PERSONNEL
TREATED WITH CHANTIX. IN MOST CASES THESE SYMPTOMS DEVELOP DURING
CHANTIX TREATMENT, BUT SYMPTOMS MAY DEVELOP FOLLOWING
WITHDRAWAL OF CHANTIX THERAPY.
7. COAST GUARD PERSONNEL CURRENTLY TAKING CHANTIX ARE STRONGLY
ENCOURAGED TO CALL THE MAYO CLINIC TOBACCO QUIT (MCTQ) AT 1-888-
642-5566 FOR COUNSELING SUPPORT AND ALTERNATIVE SMOKING CESSATION
THERAPIES. NICOTINE REPLACEMENT THERAPY (NRT) IS AVAILABLE FOR
BENEFICIARIES AT COAST GUARD CLINICS AND THROUGH MCTQ AT NO COST TO
ACTIVE DUTY MEMBERS AND THEIR DEPENDENTS, RESERVISTS ON ACTIVE DUTY
AND CG CIVILIAN PERSONNEL.  COMBINATION NRT (PATCHES, GUM,
LOZENGES) HAS BEEN SHOWN TO BE HIGHLY EFFECTIVE IN TREATING
NICOTINE DEPENDANCE AND MAY LESSON THE POTENTIAL SIDE EFFECTS OF
ENDING CHANTIX USE.
8.  COAST GUARD CIVILIAN PERSONNEL TAKING CHANTIX OR RECENTLY
DISCONTINUING USE OF CHANTIX ARE STRONGLY RECOMMENDED TO CONTACT
THEIR HEALTH CARE PROVIDER FOR ADDITIONAL INFORMATION.
9.  COMMANDING OFFICERS/OFFICERS-IN-CHARGE SHALL ENSURE THAT ALL
MEMBERS IN THEIR COMMAND ARE AWARE OF THIS ADVISORY.
10.  FOR QUESTIONS REGARDING THIS MESSAGE, CONTACT CAPT BRENT
PENNINGTON BRENT.PENNINGTON(AT)USCG.MIL OR (202) 475-5170 OR CAPT
MARY FONG AT MARY.FONG(AT)USCG.MIL OR (202) 475-5181.
11. CAPT LORI A. MATHIEU, ACTING DIRECTOR OF HEALTH, SAFETY AND
WORK-LIFE SENDS.
12. INTERNET RELEASE AUTHORIZED.