Schizophrenia is a severe
psychiatric disorder affecting 1% of the world's population.
Nicotine addiction is one of the most important health concerns for patients with
schizophrenia. An extensive body of evidence points to a high prevalence rate of comorbid
nicotine addiction in people with
schizophrenia (70-90%), which contributes to significant cardiovascular and
cancer risks in this vulnerable population. Therefore, effective smoking cessation strategies could play a major role in preventing significant morbidity and mortality in this population. Two of the most common pharmacological approaches to smoking cessation,
bupropion and
nicotine replacement therapy (NRT), have been used in psychiatric patients to reduce their smoking. In 2006,
varenicline, a partial agonist of α4β2
acetylcholine receptor, was approved for smoking cessation by the FDA. This
drug not only has the beneficial effects on
withdrawal symptoms, but also reduces craving and rewarding effects of smoking. While
varenicline has been shown to be an effective, safe medication for the general population, its efficacy and safety for subjects with
schizophrenia is less well characterized. A number of case studies have prompted FDA warnings about the potential exacerbation of psychiatric symptoms. However, other case studies and pilot studies have shown
varenicline to be a safe and effective treatment for smoking cessation in subjects with
schizophrenia.
Varenicline has the potential to reduce smoking in subjects with
schizophrenia, however, clinicians should carefully monitor patients receiving
varenicline for potential exacerbation of psychiatric symptoms.