Varenicline is a novel treatment for smoking cessation; however, the agent has not been well studied in a population with severe
mental illness.
Varenicline can reportedly cause neuropsychiatric adverse effects, some resulting in hospitalizations and/or suicides. We describe a case of clinician-observed, worsening psychotic symptoms in a patient with chronic
mental illness who was receiving
varenicline. A 45-year-old woman with
bipolar disorder, mixed type with psychotic features, was admitted to a psychiatric hospital due to acute decompensation after she discontinued her
drug therapy. Because of the facility's smoke-free policy, the patient was not permitted to
smoke cigarettes during her hospitalization. Over the next several weeks, her condition was stabilized with
psychotropic drugs. Her symptoms improved, and plans were made for her discharge.
Varenicline was prescribed to manage her
nicotine cravings. After 2 days of treatment, staff members noted worsening of the patient's psychotic symptoms and agitation.
Varenicline was discontinued, the patient's mental status returned to baseline, and she was subsequently discharged. Use of the Naranjo
adverse drug reaction probability scale indicated a probable relationship (score of 7) between the patient's worsening
psychosis and her
varenicline therapy. This case report provides valuable support of previously published cases that demonstrate the risk of exacerbation of psychotic symptoms with
varenicline use in patients with severe
mental illness. With proper assessment and management of
varenicline-induced neuropsychiatric effects, health care professionals can provide an important role in helping to prevent and manage worsening psychiatric symptoms.