Varenicline (champix)-associated manic relapse in bipolar affective disorder.

The drug varenicline (champix) is a nicotinic receptor partial agonist used as a pharmacological agent in smoking cessation. It has become the object of considerable media attention in North America due to reported links with increased suicidality and depression. Moore and Furberg analysed reports from the UK’s yellow card system and urged that doctors should monitor patients taking varenicline for abnormal behaviour, including aggressive and violent thoughts and acts, suicidal behaviour, hallucinations, and psychosis. 1 McClure et al found that patients with a pre-existing history of depression were no more likely to report neuropsychiatric side effects than those without. 2 In patients with bipolar affective disorder, manic episodes induced by varenicline have previously been reported in the literature. 3