A systematic review and meta-analysis aimed to ascertain the risk of neuro-psychiatric side-effects in patients taking varenicline (compared with those taking placebo).
1 In the 39 controlled trials analysed with approximately 10,000 patients, no evidence was found indicating an increase in the risk of suicide, attempted suicide or depression.
2 Varenicline was associated with a 25% reduction in the risk of anxiety.
3 Varenicline taken at the highest dose of 1mg twice daily was associated with an increase in the risk of sleep disorders (an increase of 63%), insomnia (an increase of 56%) and fatigue (an increase of 28%).
4 Commonly held fears about the association of suicidal behaviour with varenicline were described as ‘unfounded’ in the study.
What does this mean for GPs?
GPs should feel confident and reassured by these findings, and should continue to encourage patients to use varenicline where indicated to help them to stop smoking.
Nevertheless, they should continue to warn patients of the risk of sleep problems and fatigue.
Dr Hamed Khan is a GP in the emergency department of St George’s, London, and a clinical lecturer. He tweets as @drhamedkhan.