Varenicline PGD flow chart Process for PGD accredited Pharmacists

How to choose between NRT and Varenicline (Varenicline)? Advice for PGD accredited Pharmacists Is the patient pregnant or breastfeeding? Is the patient over 18 years old? Consider Varenicline (Champix) – course can be given once in a 12 month period Consider NRT options Has the patient tried NRT previously Yes No Consider NRT No Yes No Has the patient signed form 4 and the standard monitoring form (please keep forms together) Yes Is the patient suitable for Varenicline and agreed on a quit date in the next 2 weeks? Fill out form 5, sign and instruct patient to take form 5 to nominated PGD accredited Pharmacy Is the patient sufficiently motivated to quit? The patient needs to come back when ready Consider NRT If not interested in NRT CONSIDER VARENICLINE (C H A M P I X) Yes No Contraindications Hypersensitivity to Varenicline or any of its excipients End stage renal disease Pregnancy or breastfeeding Under 18 years of age Cautions (see PGD for full list) Renal disease Psychiatric conditions Epilepsy History or risk of an MI No Yes A See next page… Record Client ID no. Fill form 5 on subsequent sessions (offering 2 week maintenance pack supplies) – maximum of 12 weeks. Refer patient to the same Pharmacy only Advisor Process

Nominated PGD pharmacist undertakes final review before providing Varenicline starter pack Nominated PGD accredited pharmacist reviews completed letter of recommendation (form 5) once received from patient – Not a photocopy ! A Nominated PGD accredited pharmacist reviews form 5 and undertakes final review before providing Varenicline maintenance pack patient continues course of Varenicline with on-going behavioural support Patient takes form 5 to the same nominated PGD accredited pharmacy for subsequent supply (maintenance pack) Stop smoking advisor provides weekly behavioural support and signs off (form 5) additional 2 weeks of Varenicline (patient must be quit between day 8 & 14) B C Pharmacist PGD Process

PGD accredited Pharmacist to supply clearly labelled Varenicline maintenance pack including full dosage. PIL given and patient counselling (adherence issues and side effects e.g. Nausea, abnormal dreams, headaches etc). Also discuss depression episodes of concern if they were to arise and discontinue treatment immediately (See latest version of Varenicline SPC ) To be done on 1 st supply of Varenicline only (FAX LETTER OF INITIATION TO GP & S4H– form 2) PGD accredited Pharmacist to fill assessment proforma (form 3) of PGD. This is filled out with the patient (refer to PGD document throughout). Patient consent needed on all supplies B PGD accredited Pharmacist to fill record of supply form (form 1) Patient confidentiality, Data governance, Indemnity insurance No prescription levy (FREE) Record Client ID no. on all forms Pharmacist PGD Process

PGD accredited pharmacist to check if patient is suited to the treatment and if anything has changed that is of concern since they were last seen? (E.g. Allergy, Depressive episode(s)) Subsequent supplies only (and if patient has quit) - PGD accredited pharmacist issues Varenicline (maximum of 2 weeks at a time – 12 weeks total) – Contact S4H for exceptions e.g. going abroad Assessment proforma of PGD reviewed (form 3) with patient (refer to PGD document throughout) C Refer to GP and yellow card side effects d.gov.uk Discontinue use if concerned PGD accredited pharmacist to fill record of supply form (form 1) – patient signature required on all supplies Final record of supply form (form 1) send to S4H for payment GP & S4H (form 2) – fax to inform patient outcome (under additional notes) Pharmacy to retain copy of Assessment Proforma and a copy of form 1 (kept for 2 years) Patient confidentiality, Data governance, Indemnity Insurance PGD accredited pharmacist to supply clearly labelled Varenicline maintenance pack including full dosage. PIL given and patient counselling (adherence issues and side effects e.g. Nausea, abnormal dreams, headaches etc). Also discuss depression episodes of concern if they were to arise and discontinue treatment immediately (See latest version of Varenicline SPC ) No prescription levy (FREE) Pharmacist PGD Process