A Case Report on Varenicline Induced Delirium in an Alcohol and Nicotine Dependent Patient

Abstract

Varenicline is a smoking cessation agent. Varenicline acts as a partial agonist of α4β2 neuronal nicotinic acetylcholine receptor and prevents nicotine binding to the same. It also causes dopamine (DA) stimulation that decreases craving and symptoms of dependence. A 40-year-old male diagnosed with alcohol and nicotine dependence syndrome was treated with 1 mg of varenicline for 3 days. Patient developed episodes of transient delirium within 15-30 min after administration of varenicline. Patient was disoriented and did not respond relevantly. Patient would have disorientation and would respond irrelevantly and was unable to recall the event completely. There were no features suggestive of seizures. The episodes resolved after the medication was stopped. Varenicline, with its partial agonistic effect on nicotinergic receptors, stimulates the release of multiple neurotransmitters including DA. DA dysregulation is probably responsible for the development of neuropsychiatric adverse reactions due to varenicline. This is the first case report to the best of our knowledge reporting varenicline induced dilirium. In this case, the adverse event was found in an alcohol and nicotine dependent patient undergoing treatment. It is essential to monitor uncommon adverse effects as this can cause significant morbidity.

Computational evidence of a compound with nicotinic α4β2-Ach receptor partial agonist properties as possible coadjuvant for the treatment of obesity

“…Nevertheless, the effectiveness of these drugs is limited, and the appearance of major adverse cardiovascular events in obese patients with cardiovascular risk factors has brought some controversy about the cardiovascular safety of these antiobesity agents (Nissen et al, 2016). On the other hand, varenicline has numerous adverse effects with commonly are related with treatment discontinuation (Drovandi, Chen & Glass, 2016), and even a case of delirium have been previously reported (Virupaksha et al, 2015).…”

Delirium Research in India: A Systematic Review

“…99 In terms of psychotropics, delirium has been reported with discontinuation of sertraline, 100 use of olanzapine, 101 valproate associated hyperammonemia, [102][103][104] restarting of clozapine, 105 mirtazapine associated hyponatremia, 106 use of a combination of clozapine and electroconvulsive therapy (ECT), 107,108 use of a combination of lithium and ECT, 109,110 and postinjection delirium/sedation syndrome associated with olanzapine depot injection. [111][112][113][114][115] Some of the case reports/case series focus on substance-related delirium, [116][117][118][119][120][121][122][123][124][125][126][127][128] either during the withdrawal phase or intoxication phase. The case reports also cover topics like refractory delirium tremens, delayed onset delirium tremens, delirium tremens with hollow viscus perforation, genital self-mutilation in alcohol withdrawal state complicated with delirium, delirium during opioid withdrawal, 122 naltrexone precipitating delirium, 121 delirium due to use of parental tramadol, 125 varenicline-induced delirium, 126 and delirium associated with zolpidem withdrawal 127 or intoxication.…”

“…[111][112][113][114][115] Some of the case reports/case series focus on substance-related delirium, [116][117][118][119][120][121][122][123][124][125][126][127][128] either during the withdrawal phase or intoxication phase. The case reports also cover topics like refractory delirium tremens, 116 delayed onset delirium tremens, delirium tremens with hollow viscus perforation, 120 genital self-mutilation in alcohol withdrawal state complicated with delirium, 116 delirium during opioid withdrawal, 122 naltrexone precipitating delirium, 121 delirium due to use of parental tramadol, 125 varenicline-induced delirium, 126 and delirium associated with zolpidem withdrawal 127 or intoxication. 128 Delirium has also been reported in association with various physical illnesses such as nephrotic syndrome, 129 chronic lymphocytic leukemia, 130 Parkinson's disease, 131 pancreatic pseudocyst, 132 hypopituitarism, 133 postoperative state, 134 sepsis, 135 tuberculous meningitis, 136,137 and thalamic infarcts.…”