Abstract
IntroductionVarenicline is widely used for smoking cessation. It has shown efficacy over placebo and bupropion in manufacturer-sponsored trials. Those with mental illness were excluded from these trials. There are case reports of exacerbation of mental illness and development of psychiatric symptoms with varenicline use.Case presentationA 61-year-old male Caucasian being treated for post-traumatic stress disorder, depression not otherwise specified and alcohol dependence, was prescribed varenicline while he was in a post-traumatic stress disorder/alcohol dual diagnosis treatment program. He developed visual hallucinations, which became worse with titration of the medication. These symptoms resolved upon discontinuation of varenicline.ConclusionPatients with mental illness have a higher incidence of nicotine dependence, and attempts should be made for smoking cessation. Varenicline has not been widely tested in this population. There are reports of exacerbation of mental illness, and probable causation of psychiatric symptoms in the mentally ill. Providers should be aware of this possibility and advise their patients appropriately.
Highlights
Varenicline is widely used for smoking cessation
Case presentation: A 61-year-old male Caucasian being treated for post-traumatic stress disorder, depression not otherwise specified and alcohol dependence, was prescribed varenicline while he was in a post-traumatic stress disorder/alcohol dual diagnosis treatment program
Patients with mental illness have a higher incidence of nicotine dependence, and attempts should be made for smoking cessation
Summary
We report a patient with visual hallucinations that developed with varenicline use. Many patients with mental illness are concurrent smokers and the use of this product has become very common in this population. Patients with psychiatric illness have used varenicline with reported efficacy and tolerability, caution needs to be used in this population. This case highlights the need for providers to be aware of potential psychiatric symptoms with varenicline use. Providers should prescribe with caution and provide relevant education and monitoring to patients with underlying mental illness. Consent Written informed consent was obtained from the patient for publication of this case report. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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