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Biological Approaches
Published in Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews, Co-occurring Mental Illness and Substance Use Disorders, 2022
Tricia L. Chandler, Mary C. Hoke, Tara G. Matthews, Elizabeth Reyes-Fournier
Varenicline, developed in 2006, is a newer medication available for smoking cessation. It relieves symptoms of nicotine withdrawal. Varenicline works by causing the sustained release of small amounts of dopamine (Stahl, 2017).
Paper 1
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Varenicline is a new oral smoking cessation product. It should be started a week before the agreed stopping smoking date and has been approved in NICE 2007 draft guidance. Studies have shown that varenicline is twice as effective as bupropion. It is a partial agonist at the nicotine receptor. Binding alleviates the symptoms of craving and withdrawal, as well as reducing both the rewarding and reinforcing effects of nicotine.
How to Address Smoking Cessation in Areas of Deprivation
Published in James Matheson, John Patterson, Laura Neilson, Tackling Causes and Consequences of Health Inequalities, 2020
Varenicline (Champix) is a smoking cessation pharmacotherapy which works by partially agonising nicotine acetylcholine receptors [37]. Its effectiveness has been analysed, with most studies supporting its benefits. A systematic review by Cahill et al. demonstrated the effectiveness of varenicline with a two- to three-fold increase in successful smoking cessation compared to placebo. The review also showed that it had more benefit than bupropion and nicotine patches [38]. In the past, varenicline use has been linked to neuropsychiatric adverse events such as suicidal ideation and psychosis, however, the EAGLES study, the largest of its kind researching varenicline, showed no statistical difference in neuropsychiatric events when compared to placebo [39]. Varenicline has been shown to have side effects such as insomnia, headaches and nausea but is generally well tolerated [38].
Practice patterns of bupropion co-prescription with antipsychotic medications
Published in Journal of Addictive Diseases, 2022
Mohan Gautam, Shivali Patel, Paul Zarkowski
Medications tend to be prescribed together more frequently for indications with significant comorbidity. Thus, it could be viewed as unexpected that none of the antipsychotic medications were prescribed with bupropion significantly more often than chance. There is high comorbidity of tobacco use among patients whose symptoms require treatment with antipsychotic medication.6,45 Varenicline was demonstrated in the EAGLES trial to be more efficacious than bupropion to obtain continuous abstinence after 9-12 weeks. While both interventions were significantly superior to placebo, the estimated odds ratio for varenicline was greater than 3.0 compared to greater than 1.9 for bupropion.35 However, varenicline only has an FDA indication for up to 24 weeks. This may lead to lack of coverage for long term care with varenicline. Bupropion, on the other hand, does have FDA indication for long term use as evaluated for mood disorders. This limited number of options are problematic when supplies are limited, as in the recent FDA recall of 0.5 mg and 1 mg varenicline tablets.46 It is important not to discard possible medications that may help, particularly considering the additional impact of smoking on the metabolic profile of patients taking antipsychotic medication. Further study is necessary to verify the safety of these combinations.
Varenicline: mode of action, efficacy, safety and accumulated experience salient for clinical populations
Published in Current Medical Research and Opinion, 2020
Serena Tonstad, Cynthia Arons, Hans Rollema, Ivan Berlin, Peter Hajek, Karl Fagerström, Charl Els, Thomas McRae, Cristina Russ
There are a number of areas in which future research could broaden the application of varenicline. As discussed in the current article, studies that further investigate varenicline pre-loading and combination therapy with NRT or bupropion could confirm the potential benefits of these approaches. Additional research on the combination of varenicline specifically with short-acting NRT forms (gum and lozenges) or e-cigarettes also warrants further investigation. In addition, other research questions may be important that were beyond the scope of the current article. Varenicline may be a promising treatment for post-smoking cessation nicotine use in individuals who continue to use nicotine replacement products for years106. Finally, varenicline has shown some potential for indications beyond smoking cessation, including for alcohol use disorder and addiction treatment for other drugs such as cocaine107–109. Additional research could also confirm these uses.
Pharmacotherapy for smoking cessation in schizophrenia: a systematic review
Published in Expert Opinion on Pharmacotherapy, 2020
Karolina Kozak, Tony P. George
In an attempt to determine the safety of varenicline, we also examined the psychiatric rating scales (i.e. Brief Psychiatric Scale, Positive, and Negative Symptom Scales) and the frequency of adverse events. Both studies showed no significant differences between varenicline and placebo groups in positive symptoms of schizophrenia throughout trials. Additionally, Williams et al. found no exacerbation of negative symptoms between groups and reported no differences between the treatment and follow-up phase [27], while Weiner et al. found no significant differences in depression symptoms [26]. Furthermore, both studies combined were similar in reporting the most common side effects of insomnia, constipation, headache, and nausea, with the latter two found more significant in the varenicline group compared to placebo. Williams et al. (2012) reported 13 serious adverse events (SAEs), with two patients in the varenicline group having three SAEs considered to be study drug related, though both patients had a prior history of suicide attempts and hospitalization.