Varenicline
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First report of schizophrenia exacerbation: case report A 42-year-old woman experienced an exacerbation of schizophrenia during treatment with varenicline for smoking cessation. The woman had been treated with tiotixene 1015mg for 17 years and was experiencing several brief psychotic episodes per year, which rarely lasted for more than 3 days. She was also a heavy smoker with a 1–2 packs/day habit. She experienced a 5-day psychotic episode that started with increased activity, mainly the discarding of financial statements. On day 4 of the episode, she was ordered out of the house by her mother, who also disposed of her tiotixene tablets. She spent day 5 screaming in her closet and stopped eating. That evening, her mother administered tiotixene 20mg and fed her. The next morning, her psychotic symptoms had resolved and she was well groomed. It was then revealed that she had been receiving varenicline 2mg for 5 days [frequency of administration and time to reaction onset not stated]; she had not exhibited any overt psychotic symptoms 1 month earlier. Tiotixene continuation was recommended and she was advised to avoid varenicline. She did not experience further schizophrenia exacerbations, but continued to smoke. Author comment: "Prolonged release of dopamine and norepinephrine may have resulted in the activated psychotic relapse in our patient. Her relatively low neuroleptic dose likely increased her vulnerability to this effect." Freedman R. Exacerbation of schizophrenia by varenicline. American Journal of 801091200 Psychiatry 164: 1269, No. 8, Aug 2007 - USA
» Editorial comment: A search of AdisBase and Medline did not reveal any previous case reports of schizophrenia exacerbation associated with varenicline. The WHO Adverse Drug Reactions database contained no reports of schizophrenic reaction associated with varenicline.
0114-9954/10/1164-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 11 Aug 2007 No. 1164
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