Varenicline
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First report of phaeochromocytoma crisis: case report Starting treatment with varenicline for smoking cessation triggered a phaeochromocytoma crisis in a 55-year-old woman. The woman had been smoking 15 cigarettes/day for decades and had a history of hypertension treated with telmisartan, hypothyroidism treated with levothyroxine sodium and an 8-year history of palpitations. She started treatment with varenicline 0.5 mg/day. The following day, after her second dose, she reported diarrhoea, stomach ache and palpitations. The symptoms worsened and the next morning she had chest pain. In the emergency department she presented with mild hypertension but rapidly deteriorated. She was intubated and admitted to an ICU where she received milrinone, levosimendan, norepinephrine [noradrenaline] and antibiotics. A chest CT scan showed severe pulmonary oedema. She had an ejection fraction of 0.32 and no evidence of occlusive coronary artery disease. An MRI showed a left-sided adrenal mass (47 × 34 mm). The results of further investigations were consistent with an adrenal phaeochromocytoma and the mass was successfully removed. [Patient outcome not clearly stated.] Author comment: The woman "had a documented visit to the emergency department for palpitations 6 years before the current admission, suggesting that she may have had pheochromocytoma for years without crises. This emphasizes the importance of the temporal relation of varenicline exposure to the crisis". Hukkanen J, et al. Varenicline and pheochromocytoma. Annals of Internal 803013924 Medicine 152: 335-6, No. 5, 2 Mar 2010 - Finland
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Editorial comment: A search of AdisBase, Medline, Embase and the WHO ADR database did not reveal any previous case reports of phaeochromocytoma associated with varenicline.
0114-9954/10/1301-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 15 May 2010 No. 1301
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