Neuropsychiatric disturbance after initiation of varenicline in a patient with a history of alcohol abuse and major depression.

PURPOSE: The case of a patient with a history of alcohol abuse and major depression who developed neuropsychiatric symptoms after initiation of varenicline is reported.
SUMMARY: A 33-year-old Caucasian man was prescribed varenicline for smoking cessation. He had a history of hypertension, alcohol dependency, major depression, and hypothyroidism. The patient's only reported allergy was to morphine. The patient reported smoking four or five cigarettes daily for 10 years and discontinued alcohol use 2 years before varenicline initiation. He was prescribed varenicline 0.5 mg once daily; after three days, the dosage was increased to 0.5 mg twice daily, based on recommendations in the package insert. On the evening of the seventh day, after taking 10 doses of varenicline, the patient developed severe anxiety, nausea, vertigo, blurred vision, and dizziness. He reported to his physician's office where his blood pressure was 120/75 mm Hg and his heart rate was approximately 70 beats/min. His laboratory test results were unremarkable for liver and kidney dysfunction. Since the only recent change to his drug therapy was the initiation of varenicline, the drug was discontinued, after which his symptoms subsided gradually and completely disappeared after three days. The patient declined rechallenge with varenicline one week later. The patient's score on the Naranjo et al. adverse drug reaction probability scale was 6, indicating a probable relationship between treatment with varenicline and the patient's symptoms.
CONCLUSION: A patient with a history of alcohol dependence and major depression developed severe anxiety, nausea, vertigo, blurred vision, and dizziness after initiation of varenicline.