Jack, a 60-year-old male taking varenicline for smoking cessation reports that he has been suffering from

vivid dreams and has become increasingly aggressive towards his family. Last night he had a major
argument with his wife. His wife mentioned he hadn't been the same since he started the varenicline
and he would like to know if this was a possible cause.

Is varenicline a possible cause of his vivid dreams and aggression?

 Varenicline, sold under brand names Chantix and Champix, is a medication used for smoking
cessation. Vivid dreams and aggression have been reported in association with Varenicline by
multiple sources and has been acknowledge as an adverse drug reaction of the medication.

 Aside from vivid dreams and aggression, it has also been reported that Varenicline has been
associated with suicidal thoughts, self-harm behavior, and depression.
Is this a reportable adverse drug reaction?

 The first generic Varenicline has been approved by the FDA just recently (August 2021). Since this is
still a new drug, any suspected adverse drug reaction must be immediately reported to the FDA.

Redo medication reconciliation if necessary

Considering the adverse drug reactions associated with Varenicline, other alternative first-line
pharmacotherapies for smoking cessation include Nicotine Replacement Therapy (NRT) and Bupropion.
These treatments aim to reduce symptoms of nicotine withdrawal, making it easier for smokers to stop
using cigarettes.

 Nicotine Replacement Therapy (NRT)

: To relieve nicotine withdrawal symptoms by providing nicotine without the use of tobacco, while
breaking the behavior of cigarette smoking. (Does not include electronic cigarettes)

This includes the following:

: Nicotine Transdermal Patch (Long acting)
: Nicotine Gum
: Nicotine Lozenge
: Nicotine Inhalers
: Nicotine Nasal Spray
: Nicotine Mouth Spray
: Nicotine Sublingual Tablets

 Bupropion
: This is safe for individuals with stable CV and COPD but ineffective for those hospitalized for Acute
Myocardial Infarction.
: It is contraindicated in patients with a seizure disorder (risk is dose-dependent and other risk
factors for seizures)