Distúrbios mentais estáveis não contra-indicam medicações para abandono de tabagismo

Safety of smoking cessation medications in patients with and without mental health disorders

Reports of newly emergent depression, suicidal ideation, and suicidal behavior among patients receiving bupropion or varenicline for smoking cessation raised questions about the safety of these drugs in smokers with mental health disorders. In a recent trial examining the safety of these medications, more than 8000 motivated adult smokers, approximately half with clinically stable mental health disorders, were randomly assigned to varenicline, bupropion, transdermal nicotine, or placebo for 12 weeks [1]. Compared with patients without mental health disorders, patients with such disorders were more likely to experience neuropsychiatric adverse events (including anxiety, depression, agitation, or hostility) during treatment (2.1 versus 5.8 percent). However, in both patients with and without mental health disorders, the rate of events did not differ for patients assigned to varenicline or bupropion compared with placebo. Rates of smoking abstinence were higher with each of the three drugs compared with placebo, and higher with varenicline compared with bupropion or transdermal nicotine. The findings are consistent with previous, smaller trials supporting carefully monitored use of smoking-cessation medications in smokers with stable mental health disorders.

See 'Pharmacotherapy for co-occurring schizophrenia and substance use disorder', section on 'Safety'.

1. Anthenelli RM, Benowitz NL, West R, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet 2016.