Varenicline induced psychosis in schizophrenia

Gupta, Arun; Bastiampillai, Tarun; Adams, Maxwell; Nelson, Allan; Nance, Michael

doi:10.1177/0004867412444993

Cited by 7 publications

(4 citation statements)

References 4 publications

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“…When explored further, we found no clear association for psychoses, suggesting that previous reported cases of varenicline induced psychoses were not causal. 11 12 13 14 15 However, the risk remained for anxiety (hazard ratio 1.27, 1.06 to 1.51) and mood (1.28, 1.07 to 1.52) conditions. When we stratified on psychiatric history, associations remained only for people with a history of psychiatric conditions.…”

Section: Discussionmentioning

confidence: 99%

“… 9 10 Some weaker evidence also suggests an increased risk of violence and psychosis. 10 11 12 13 14 15 However, these increased risks are based on post-marketing surveillance and case reports, 9 11 12 13 14 15 16 17 18 19 which are not consistent with observational data and randomised controlled trials that have found no association between varenicline and depression, suicidality, or violence. 4 20 21 22 23 24 25 26 27 28 These inconsistencies could be explained by differences in study designs, confounding by comorbid psychiatric disorders or by indication bias (that is, the same factors may influence both institution of treatment and outcomes), or reporting bias.…”

Section: Introductionmentioning

confidence: 96%

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Varenicline and risk of psychiatric conditions, suicidal behaviour, criminal offending, and transport accidents and offences: population based cohort study

Molero

Lichtenstein

Zetterqvist

et al. 2015

BMJ

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ObjeCtiveTo examine associations between varenicline and the incidence of a range of adverse outcomes. DesignPopulation based cohort study using within person analyses to control for confounding by indication. Main OutCOMe MeasuresIncidence of new psychiatric conditions, suicidal behaviour, suspected and convicted criminal offending, transport accidents, and suspected and convicted traffic offences. resultsIn the whole population, 337 393 new psychiatric conditions were diagnosed during follow-up. In addition, 507 823 suspected and 338 608 convicted crimes, 40 595 suicidal events, 124 445 transport accidents, and 99 895 suspected and 57 068 convicted traffic crimes were recorded. Within person analyses showed that varenicline was not associated with significant hazards of suicidal behaviour, criminal offending, transport accidents, traffic offences, or psychoses. However, varenicline was associated with a small increase in the risk of anxiety conditions (hazard ratio 1.23, 95% confidence interval 1.01 to 1.51) and mood conditions (1.31, 1.06 to 1.63), which was only seen in people with pre-existing psychiatric disorders. COnClusiOnsConcerns that varenicline is associated with an increased risk of many adverse outcomes, including suicidality and accidents, are not supported in this observational study. The small increase in risk of two psychiatric conditions in people with pre-existing psychiatric disorders needs to be confirmed using other research designs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Varenicline and risk of psychiatric conditions, suicidal behaviour, criminal offending, and transport accidents and offences: population based cohort study

Molero

Lichtenstein

Zetterqvist

et al. 2015

BMJ

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“…Gupta et al, for example, reported a patient with preexisting schizophrenia, stable on 25 mg risperidone intramuscular (IM) injection fortnightly that had a breakthrough psychosis five days after the initiation of varenicline. The patient returned to her baseline after stopping varenicline without changing her initial medication regimen [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

First Episode of Psychosis in the Context of Varenicline Treatment for Smoking Cessation

Zoghbi¹,

Barazi²,

Abdelkader³

et al. 2023

Cureus

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Smoking is one of the leading causes of preventable death worldwide. Several pharmacological therapies have been established over the years to aid in smoking cessation, including Varenicline, a partial nicotine agonist. Neuropsychiatric adverse events have been reported in patients treated with Varenicline. Here, we present a case of first-episode psychosis in the context of Varenicline therapy. The patient's chart was retrospectively reviewed for relevant medical and psychiatric history, in addition to the use of current or past medications. Routine laboratory investigations and brain imaging were performed. The Naranjo Adverse Drug Reaction Probability Scale was also done independently by two physicians involved in the patient's treatment.He was admitted for psychotic symptoms elicited in the context of a probable adverse reaction to Varenicline. The current evidence linking Varenicline to psychosis remains controversial. Speculatively, there could be a link between Varenicline, which supposedly increases dopamine levels in the prefrontal cortex through the mesolimbic pathways, and psychotic symptoms. It is therefore beneficial to be cognizant, in a clinical setting, of the possibility of the emergence of these symptoms with Varenicline therapy.

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“…If we consider the secondary endpoints, the profile of varenicline tolerability is an aspect which was often evaluated. In particular, the medication has shown a good profile of safety and efficacy, though in some categories of patients, such as those with active psychiatric diseases, there were cases of psychosis [52]. Maybe this particular aspect should be more investigated creating safety-based trials with primary outcomes designed especially to focus on the psychiatric side effects.…”

Section: Discussionmentioning

confidence: 99%

Varenicline and evaluated outcomes in smoking cessation programmes

Santus

Bassi

Airoldi

et al. 2015

Monaldi Arch Chest Dis

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The morbidity and mortality rates attributed to smoking are substantial and cigarette smoke remains the first preventable cause of premature death worldwide. Despite the knowledge of the adverse consequences of smoking, many smokers struggle to quit. Cigarette smoking is the primary cause of chronic obstructive pulmonary disease, and smoking cessation represents the most effective way of stopping its progression. Varenicline is one of the first-line smoking cessation aids recommended in many Clinical Practice Guidelines and its efficacy and safety have been demonstrated in several clinical trials. Varenicline has a unique mechanism of action and clinical trials support its use as an effective and generally well-tolerated therapy. This article reviews the clinical pharmacological trials on smoking cessation published in recent years on varenicline, with particular attention to the outcomes used in the studies. MedLine, the Cochrane database and Embase were evaluated. Almost all the trials have, as a primary endpoint, the abstinence from cigarettes at 9-12 weeks of treatment. Only one study considers lung function spirometric changes as a secondary endpoint. No study has evaluated lung function. This marker could be very important as a way of evaluating, objectively, an improvement in lung function, which correlates also with subjective parameters, as dyspnea and fatigue.

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Varenicline induced psychosis in schizophrenia

Cited by 7 publications

References 4 publications

Varenicline and risk of psychiatric conditions, suicidal behaviour, criminal offending, and transport accidents and offences: population based cohort study

Varenicline and risk of psychiatric conditions, suicidal behaviour, criminal offending, and transport accidents and offences: population based cohort study

First Episode of Psychosis in the Context of Varenicline Treatment for Smoking Cessation

Varenicline and evaluated outcomes in smoking cessation programmes

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