Varenicline a Potential Treatment Option for Alcohol Use Disorders in Smokers and Nonsmokers

Varenicline is a partial α4β2 nicotinic acetylcholine agonist approved for smoking cessation. Preclinical studies have suggested reduced alcohol intake in the setting of varenicline; a human laboratory study suggested reduced drinking, alcohol craving, and reinforcing effects of alcohol intake in individuals with heavy smoking and drinking behaviors; and a small preliminary study of smokers with heavy drinking given varenicline for 3 weeks suggested a greater reduction in alcohol craving and fewer heavy drinking days over placebo. This is the first reported multi-site clinical trial of varenicline in smokers and nonsmokers with alcohol dependence. Two hundred patients with alcohol dependence were randomized to receive double-blind varenicline or placebo plus a computerized behavioral intervention for 13 weeks.

• Patients in the varenicline group reported a lower weekly percentage of heavy drinking days over those in the placebo group (38% versus 48%, respectively). Smoking status did not alter the primary outcome.
• The varenicline group had fewer drinks per drinking day (6 versus 7) and a lower percentage of very heavy drinking days over placebo (18% versus 26%).
• Abstinence did not differ between the two groups.
• Adverse events were those expected and varenicline was well tolerated between the two groups.

Comments:

In this study, varenicline reduced alcohol consumption among smokers and nonsmokers compared with placebo. Larger, longer-duration studies are needed to replicate the data presented in this proof-of-concept trial.

Jeanette M. Tetrault, MD

Reference:

Litten RZ, Ryan ML, Fertig JB, et al. A double-blind, placebo-controlled trial assessing the efficacy of varenicline tartrate for alcohol dependence. J Addict Med. 2013;7(4):277–286.