Varenicline: aggression and homicidal ideation

Varenicline, a drug used for smoking cessation, carries a risk of neuropsychological adverse effects, including depression and suicide. Analysis of a series of detailed reports of aggression and homicidal ideation attributed to varenicline showed that most patients had no psychiatric history. These symptoms were often preceded by sleep disorders. Suicide and suicidal ideation were associated with signs of aggression in nearly one-third of cases. Aggressive symptoms recurred in patients who restarted varenicline. In practice, it is better to avoid using varenicline for smoking cessation and to use nicotine replacement instead when drug therapy is considered necessary.