title: Low incidence of adverse events following varenicline initiation among opioid dependent smokers with comorbid psychiatric illness.
abstract: BACKGROUND
  Most drug treatment patients smoke cigarettes, yet few data exist on the prevalence and outcomes of varenicline treatment among smokers with comorbid substance use and psychiatric disorders.
  
  
  METHODS
  We reviewed all patient charts of opioid-dependent smokers prescribed varenicline between May 2006 and December 2009 in two urban methadone clinics that also provide on-site medical and psychiatric care. We assessed prevalence, adverse events, and effectiveness of varenicline treatment in this cohort.
  
  
  RESULTS
  We identified 575 smokers among 690 patients (83.3%), and assessed 82 courses of varenicline treatment prescribed to 70 smokers. Both cardiovascular risk factors and psychiatric illness were highly prevalent among those prescribed varenicline: hypertension, 51%; hyperlipidemia, 23%; diabetes, 20%; depression, 53%; anxiety, 30%; psychotic disorders, 10%; bipolar disorder, 8.6%. Of 82 varenicline courses, nine (11%) were discontinued due to adverse events and two due to depressive symptoms. One patient initiated new psychiatric medications within six months of initiating varenicline, but did not discontinue varenicline. There were no reports of suicidal ideation, agitation prompting clinical intervention, or psychiatric hospitalization. There were no incident cardiac or vascular events within six months of varenicline prescription. Some (8.6%) varenicline-treated smokers quit smoking, and cessation was significantly associated with varenicline treatment duration.
  
  
  CONCLUSIONS
  Despite substantial comorbidity, opioid-dependent smokers receiving integrated substance abuse, medical and psychiatric care had few documented adverse events with varenicline treatment. Methadone patients will likely experience little harm and a great deal of benefit from treatment with varenicline for smoking cessation.
authors: Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. snahvi@dosa.aecom.yu.edu
authors: Shadi
authors: S
authors: Nahvi
authors: Bryan
authors: B
authors: Wu
authors: Kimber P
authors: KP
authors: Richter
authors: Steven L
authors: SL
authors: Bernstein
authors: Julia H
authors: JH
authors: Arnsten
mesh_terms: D001552:Benzazepines / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000523:psychology; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation; D015995:Prevalence; D011320:Primary Health Care; D011810:Quinoxalines / Q000009:adverse effects*; D012907:Smoking / Q000188:drug therapy* / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D009294:Narcotics; D018722:Nicotinic Agonists; D011810:Quinoxalines; D008691:Methadone; D000068580:Varenicline
keywords: Adverse events; Opioid dependence; Smoking cessation; Varenicline