Tag Archives: chemical dopamine

Anti-Smoking Drug Chantix Tied to Serious Mental Illness

Melinda and Kenny Peterson wanted to kick their two-pack-a-day smoking habit.

In early January, the Green Bay couple started taking three-month prescriptions of Chantix, a new anti-smoking pill. About six weeks later, they weren’t smoking at all.

But what the Petersons didn’t know was that as they were weaning themselves off cigarettes, the U.S. Food and Drug Administration issued an alert.

Chantix Causes Neuropsychiatric Symptoms

Some patients taking the powerful drug had experienced serious neuropsychiatric symptoms. And Pfizer, the maker of Chantix, had recently added a warning about these symptoms in a more prominent position in the drug’s information packet, at the FDA’s urging.

The alert was issued in early February. But the Petersons didn’t know about it until the end of March, when a friend who was a pharmacist filled them in.  By then, it was too late. About a week earlier, Kenny Peterson had spiraled into a deep depression. He told his wife he wanted to kill himself. His family checked him into a hospital psychiatric ward four days before Easter. Chantix’s safety is now under fire, as similar stories of patients with suicidal thoughts, depression and aggressive behavior surface. The FDA received reports of 37 suicides and 491 cases in which people had suicidal thoughts. The FDA also said it “appears increasingly likely that there is an association between Chantix and serious neuropsychiatric symptoms.” About 5 million people use the drug.

“I think the jury is still out on what’s going on here,” said Carlyle Chan, a professor in the psychiatric department at the Medical College of Wisconsin. “Be aware that there are some concerns about (Chantix). It needs to be watched closely.”

A Pfizer spokeswoman said the company was rolling out Chantix globally but halted advertising the drug to consumers in February. The FDA approved the drug in May 2006.

The company maintained that the serious neuropsychiatric symptoms are rare, but physicians and patients should be on the lookout for them. Pfizer said a causal relationship between the drug and these symptoms has not been determined.

“The real problem out there right now is smoking,” Senior Vice President and Chief Medical Officer Joe Feczko said at a health investor conference in March.

Chantix can help shrink the global population of 1.3 billion smokers, he said, thus addressing health problems such as cancer and cardiovascular disease. In 2007, Chantix brought in $883 million in revenue.

Chantix, known generically as varenicline, works by blocking nicotine receptors in the brain. When people smoke, nicotine attaches to receptors and the brain releases the chemical dopamine, which gives pleasure. Chantix activates the receptors and blocks nicotine from attaching to them.

Before You take Chantix Be WarnedThe drug now includes a mention of possible serious neuropsychiatric symptoms in a warning section of the printed information that accompanies each prescription and is folded inside the packaging. Previously, the information was in a less prominent place in a section of the drug’s literature in which “adverse events” were reported. But there is no requirement to put the warning on the actual package because the FDA hasn’t mandated it.

None of this is comforting to Melinda Peterson, who believes that Chantix cost her family too much.

In the psychiatric ward, Kenny Peterson was diagnosed with bipolar disorder. He’s out of the hospital now but can’t work, and his doctors said they wouldn’t know when he would be able to work.

“He is completely mentally ill right now,” Melinda Peterson said. “My belief is that the drug caused him to go into a manic episode. He has paranoia. He has delusions.”

Chan said it was unclear whether Chantix actually caused depression and suicidal thoughts or whether Chantix exacerbated the symptoms of people who already have some sort of depressive behavior.

The FDA reported that it has seen both types of situations – some in which patients had no history of depression, and cases in which depression previously was an issue.

Source: Ellen Gabler,  journalsentinel.com

Future of Nicotine Levels in Cigarettes Uncertain

Washington – The Food and Drug Administration may soon have the ability to regulate sales, distribution and advertising of tobacco products, but it would not be allowed to require removal of nicotine from cigarettes.

Nicotine, the most addictive ingredient in a cigarette, increases the level of the dopamine neurotransmitters in the brain.

Dopamine controls many important responses in the brain, such as behavior.

Nicotine spreads in the brain within a few minutes of the first inhalation, creating feelings of reward, which then cause the smoker to continue smoking.

“People may smoke for non-nicotine reasons, but it is the nicotine that is the primary addictive component of cigarettes,” said Dr. Allison Chausmer from the National Institute of Drug Abuse.

American Lung Association Graph of Chemicals in CigarettesAlthough the FDA would not be able to get rid of nicotine altogether under the bill being considered by Congress, it would have the power to reduce nicotine levels in tobacco products.

The possible benefits for smokers, just like the bill, remain debatable.

A study by the National Institute of Drug Abuse found that tapered reduction of nicotine in cigarettes over a four-week span led one-fourth of smokers who were not trying to quit to spontaneously stop smoking after returning to their regular cigarettes.

“If a cigarette has nicotine levels that are below the level that people find rewarding, it may result in a reduced incidence of smoking initiation and/or increased incidence of quitting,” Chausmer said.

Chausmer also said that if the FDA lowers the nicotine content of cigarettes, “Fewer people will become addicted, and those who are addicted may find it easier to quit.”

However, smokers’ behavior varies, and some, if faced with lower nicotine levels in cigarettes, might smoke more to achieve the same nicotine satisfaction. Chausmer noted that smoking more cigarettes would mean spending more money and taking more time away from work or friends because of today’s smoke-free workplaces and restaurants.

The bill that would give the FDA regulatory power was approved by a House committee last week and will move to the House floor in the coming months.

Source: Farah Khan, Medill Reports, Northwestern University