title: Varenicline may trigger severe hypoglycaemia in Type 1 diabetes.
abstract: BACKGROUND
  Varenicline is a new drug indicated for smoking cessation. It has primarily been investigated in healthy adults. The commonest side-effects are nausea, headache, sleep disturbance, constipation, flatulence and vomiting. Hypoglycaemia has not been reported. As smoking cessation is important to reduce risk of cardiovascular morbidity, especially in diabetes, use of effective drugs indicated for smoking cessation is rational.
  
  
  METHODS
  We report multiple episodes of severe hypoglycaemia after starting varenicline in a 53-year-old woman with Type 1 diabetes. Since onset of diabetes at age 25 years and until start of varenicline therapy, she had only experienced one episode of severe hypoglycaemia and hypoglycaemia awareness was not impaired. The severe hypoglycaemic episodes disappeared after withdrawal of varenicline.
  
  
  CONCLUSIONS
  We recommend cautious prescription of varenicline, intensified blood glucose monitoring and careful education of patients with diabetes treated with varenicline. Further investigation of the use of varenicline in patients with diabetes is warranted.
authors.affiliation: Endocrinology Section, Division of Internal Medicine, Hillerød Hospital, Hillerød, Denmark. pelk@noh.regionh.dk
authors.forename: P L
authors.initials: PL
authors.lastname: Kristensen
authors.forename: U
authors.initials: U
authors.lastname: Pedersen-Bjergaard
authors.forename: B
authors.initials: B
authors.lastname: Thorsteinsson
mesh_terms: D001552:Benzazepines / Q000009:adverse effects*; D001786:Blood Glucose / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D008875:Middle Aged; D011810:Quinoxalines / Q000009:adverse effects*; D016540:Smoking Cessation / Q000379:methods*; D016896:Treatment Outcome; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D011810:Quinoxalines; D000068580:Varenicline