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Journal of Postgraduate Medicine, Vol. 56, No. 1, January-March, 2010, pp. 50 Letter Varenicline for smokeless tobacco dependence Aggarwal A1 , Jain M2 , Jiloha RC3 Department of Psychiatry, 1Indira Gandhi Medical College, Shimla, 2 Dr RML Hospital, New Delhi, 3 Maulana Azad Medical College and Associated G.B. Pant Hospital, New Delhi, India Correspondence Address: Dr. Ashish Aggarwal, Department of Psychiatry, Indira Gandhi Medical College, Shimla, India, drashish1980@gmail.com Code Number: jp10022 PMID: 20393259 DOI: 10.4103/0022-3859.62414 Sir, A 35-year-old man was referred to the psychiatry department from the dental outpatient department with complaints of excessive tooth decay and blackening of the entire tooth. History revealed use of smokeless tobacco in the form of Khaini (a form of smokeless tobacco used in India) around four packets per day for the last 10 years. He denied any history of smoking. The patient previously had made several attempts to stop use of smokeless tobacco both without and with the help of a psychiatrist but would not be able to quit for more than two weeks. He was tried on bupropion alone, as well as in combination with nicotine chewing gums, along with counseling sessions. There was no other significant psychiatric history or any medical history. Patient reported desire to quit tobacco use but was not able to do so. Varenicline therapy was explained to him and he agreed to a trial of this drug. The patient was started on varenicline 0.5 mg per day increased on fourth day to 0.5 mg twice daily and subsequently increased to 1 mg twice daily. The patient was also engaged in counseling sessions explaining the harmful effects of tobacco use and the importance of quitting it. The quit date was decided after one week of start of varenicline. The patient, after about two weeks of start of varenicline, noted a reduction in cravings for smokeless tobacco and at six weeks he was tobacco-free. Counseling sessions were continued at a frequency of one session per two weeks. The medication was continued for a total of 12 weeks, and the patient had no difficulties and did not experience any withdrawal symptoms. After discussion with the patient, varenicline was continued for another 12 weeks without any relapse of tobacco use nor did he experience any adverse effect. The patient was followed up for a period of nine months and he was still abstinent from tobacco use. Varenicline was stopped after a total of 24 weeks. Smokeless tobacco use is an important health hazard, especially in developing countries, where it contributes to around 40% of total tobacco consumed. Its use is associated with various dental problems and also systemic health hazards. [1] Despite widespread use of smokeless tobacco, relatively few data have appeared in the literature regarding treatment of addiction to it. [2] Varenicline is a recent agent approved in 2006 for smoking cessation. It is an α4 β2 neuronal nicotinic acetylcholinergic receptor partial agonist. [3] Its mechanism of action suggests that it might be useful for patients with smokeless tobacco dependence also, though till date no such reports have been published. Further studies are needed with a larger population to quantify the efficacy of varenicline along with counseling in the treatment of nicotine addiction caused by smokeless tobacco. References
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