Varenicline for tobacco-dependence treatment in alcohol-dependent smokers: A randomized controlled trial

• Published in: Drug and alcohol dependence 2018-03, Vol.184, p.12-17
• Main Authors: Hurt, Ryan T., Ebbert, Jon O., Croghan, Ivana T., Schroeder, Darrell R., Hurt, Richard D., Hays, J. Taylor
• Format: Article
• Language: English
• Subjects: Abstinence; Abuse; Adult; Aged; Alcohol abuse; Alcohol Drinking - drug therapy; Alcohol Drinking - epidemiology; Alcohol Drinking - psychology; Alcohol use; Alcohol use disorder; Alcoholic beverages; Alcoholism; Alcoholism - drug therapy; Alcoholism - epidemiology; Alcoholism - psychology; Alcohols; Cigarettes; Clinical research; Clinical trials; Critical incidents; Dependence; Drinking behavior; Drinks; Drug abuse; Drug addiction; Drug therapy; Efficacy; Evidence-based medicine; Female; Humans; Male; Medical research; Middle Aged; Nicotine; Nicotinic Agonists - therapeutic use; Pharmacology; Pharmacotherapy; Pilot Projects; Smokers - psychology; Smoking; Smoking - drug therapy; Smoking - epidemiology; Smoking - psychology; Smoking cessation; Smoking Cessation - methods; Tobacco; Tobacco Use Disorder - drug therapy; Tobacco Use Disorder - epidemiology; Tobacco Use Disorder - psychology; Varenicline - therapeutic use; Young Adult
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2017.11.017

•Varenicline improved smoking abstinence in those with alcohol abuse or dependence.•Mean alcoholic drinks per drinking day was lower after treatment with varenicline.•Adverse events were minor and comparable to those in large trials of varenicline. Tobacco use is prevalent among persons with alcohol abuse and dependence. Varenicline has been shown to be the most effective pharmacotherapy for smoking cessation and may decrease alcohol consumption. The purpose of this study was to evaluate the efficacy of 12 weeks of varenicline for increasing smoking abstinence rates in smokers with alcohol abuse or dependence. Participants were eligible for enrollment if they were 18 years or older, smoked 10 or more cigarettes per day for at least 6 months, had current alcohol abuse or dependence, and were interested in quitting smoking. Participants were randomly assigned to receive 12 weeks of varenicline 1 mg twice daily or matching placebo. The primary end point was 7-day point prevalence smoking abstinence at week 12. The 7-day point prevalence smoking abstinence rate at 12 weeks was significantly higher with varenicline (n = 16) than placebo (n = 17) (43.8% vs 5.9%; P = .01). At 24 weeks, the 7-day point prevalence smoking abstinence rate was still significantly higher with varenicline than placebo (31.3% vs 0%; P = .02). At 12 weeks, mean (SD) drinks per drinking day was significantly lower with varenicline than placebo (5.7 [3.9] vs 9.0 [5.3] drinks; treatment effect estimate, −2.8 [90% CI, −6.6 to −1.0]). Adverse events were minor and comparable to varenicline clinical trials. Varenicline is safe and efficacious for increasing smoking abstinence rates in smokers with alcohol abuse or dependence. Varenicline may decrease alcohol consumption in this population of smokers.