title: Effect of varenicline on individual nicotine withdrawal symptoms: a combined analysis of eight randomized, placebo-controlled trials.
abstract: BACKGROUND
  Concerns exist that varenicline may cause neuropsychiatric side effects. Some of these symptoms (e.g., depression, irritability) have been measured in clinical trials using nicotine withdrawal scales. This study assessed the effect of varenicline on neuropsychiatric and other symptoms, as measured by the Minnesota Nicotine Withdrawal Scale (MNWS).
  
  
  METHODS
  We analyzed weekly individual MNWS symptom ratings in 8 randomized double-blind, placebo-controlled smoking cessation trials funded by Pfizer with similar methodology (n = 2,403 varenicline; n = 1,434 placebo). Ratings for the past 24hr were obtained prior to quitting and starting treatment and at Weeks 1-6 and 11 after the quit date.
  
  
  RESULTS
  In repeated measures analyses controlling for baseline values, ratings for 5 neuropsychiatric symptoms (depressed mood, irritability, anxiety, difficulty concentrating, and restlessness) and urge to smoke were lower (p < .01) for varenicline than placebo at each timepoint. Worsening in scores from 0-2 (baseline) to 4 was less frequent on varenicline than placebo for all ratings except appetite- (significantly more frequent for varenicline, p < .0001) and sleep-related items. Repeated measures analysis for individuals with low levels of exhaled carbon monoxide revealed similar patterns except for a nonsignificant difference for increased appetite.
  
  
  CONCLUSIONS
  Use of varenicline while trying to quit smoking reduces and does not increase neuropsychiatric symptoms such as depressed mood and irritability measured on the MNWS in smokers without current psychiatric disorders. It is associated with increases in sleep disturbance and appetite although the latter appears due to enabling more subjects to abstain from smoking.
authors.affiliation: Department of Public Health Sciences, Penn State University, Hershey, PA;
authors.forename: Jonathan
authors.initials: J
authors.lastname: Foulds
authors.forename: Cristina
authors.initials: C
authors.lastname: Russ
authors.forename: Ching-Ray
authors.initials: CR
authors.lastname: Yu
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Zou
authors.forename: Aaron
authors.initials: A
authors.lastname: Galaznik
authors.forename: Mikael
authors.initials: M
authors.lastname: Franzon
authors.forename: Arthur
authors.initials: A
authors.lastname: Berg
authors.forename: John R
authors.initials: JR
authors.lastname: Hughes
mesh_terms: D000328:Adult; D000368:Aged; D001552:Benzazepines / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000009:adverse effects*; D018722:Nicotinic Agonists / Q000494:pharmacology / Q000627:therapeutic use*; D011810:Quinoxalines / Q000494:pharmacology / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000188:drug therapy / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology*; D000074606:Smoking Prevention; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000523:psychology; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D018722:Nicotinic Agonists; D011810:Quinoxalines; D009538:Nicotine; D000068580:Varenicline