On November 20, 2007, the FDA issued an “early communication” warning about possible dangerous side effects of Chantix (varenicline), a new smoking cessation agent that affects brain nicotine receptors. Several cases of new-onset depression, suicidal ideation, and aggressive or erratic behavior have been reported via the Medwatch program. In addition, Carter Albrecht, a prominent Dallas musician who was in the band Edie Brickell and the New Bohemians, died a violent death after a series of events that his girlfriend claims were triggered by hallucinatory dreams caused by Chantix. Since alcohol use was involved in Albrecht’s death, it’s not clear whether his symptoms were caused by Chantix or an interaction between Chantix and alcohol, or whether the agent was an innocent pharmacological bystander. In addition, since nicotine withdrawal alone can cause depression or agitation, some of the reported events may be unrelated to the medication, although the FDA reports that behavioral changes occurred before the patients stopped smoking in some cases (accessed online at http://www.fda.gov/ cder/drug/early_comm/varenicline.htm).

TCPR’s Take: At this point, it appears that Chantix is safe for most people, but you should inform patients of the possi- bility of strange dreams, depression, and agitation after beginning the medication. Consider prescribing an as-needed benzo- diazepine or hypnotic. If they notice any unusual behaviors, they should stop taking the drug immediately.