Varenicline decreases alcohol consumption in heavy-drinking smokers

Jennifer M Mitchell,Candice H Teague,Andrew S Kayser,Howard L Fields,Selena E Bartlett

doi:10.1007/s00213-012-2717-x

Jennifer M Mitchell, Candice H Teague + Show 3 more

Open Access

https://doi.org/10.1007/s00213-012-2717-x

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Abstract

RationaleEmerging evidence suggests that the α4β2 form of the nicotinic acetylcholine receptor (nAChR) modulates the rewarding effects of alcohol. The nAChR α4β2 subunit partial agonist varenicline (Chantix™), which is approved by the Food and Drug Administration for smoking cessation, also decreases ethanol consumption in rodents (Steensland et al., Proc Natl Acad Sci U S A 104:12518–12523, 2007) and in human laboratory and open-label studies (Fucito et al., Psychopharmacology (Berl) 215:655–663, 2011; McKee et al., Biol Psychiatry 66:185–190 2009).ObjectivesWe present a randomized, double-blind, 16-week study in heavy-drinking smokers (n = 64 randomized to treatment) who were seeking treatment for their smoking. The study was designed to determine the effects of varenicline on alcohol craving and consumption. Outcome measures included number of alcoholic drinks per week, cigarettes per week, amount of alcohol craving per week, cumulative cigarettes and alcoholic drinks consumed during the treatment period, number of abstinent days, and weekly percentage of positive ethyl glucuronide and cotinine screens.ResultsVarenicline significantly decreases alcohol consumption (χ 2 = 35.32, p < 0.0001) in smokers. Although varenicline has previously been associated with suicidality and depression, side effects were low in this study and declined over time in the varenicline treatment group.ConclusionsVarenicline can produce a sustained decrease in alcohol consumption in individuals who also smoke. Further studies are warranted to assess varenicline efficacy in treatment-seeking alcohol abusers who do not smoke and to ascertain the relationship between varenicline effects on smoking and drinking.

Highlights

Alcoholism has immense social, medical, and financial costs
Animal studies indicate that neuronal nicotinic acetylcholine receptors, contribute to the rewarding effects of alcohol (Bito-Onon et al 2011)
Five drop outs were due to adverse events (AEs; see below)

Summary

Introduction

Three drugs are approved by the Food and Drug Administration (FDA) for the treatment of alcohol abuse and dependence in the USA: disulfiram, naltrexone, and acamprosate. Varenicline, Psychopharmacology (2012) 223:299–306 a partial agonist at α4β2 nAChRs, reduces both nicotine reward and ethanol seeking and consumption in rodent models (Chatterjee et al 2011; Steensland et al 2007) Consistent with these rodent studies, two recent human laboratory and open-label studies have reported that varenicline can reduce alcohol self-administration in heavy-drinking smokers (Fucito et al 2011; McKee et al 2009). These studies suggest that varenicline is safe in humans who are using alcohol, an important factor in the development of new pharmacotherapies for individuals with alcohol abuse and/or dependence

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