Varenicline Curbs Alcohol Cravings, Increases Abstinence in Smokers

WASHINGTON – The antismoking drug varenicline also appears to curb alcohol cravings in smokers who are heavy drinkers, results of a small pilot study show.

Nondependent heavy drinkers taking varenicline (Chantix) were more likely to be abstinent during the 2-hour period of free access to alcoholic drinks than were those in the placebo group, based on logistic regression analysis, Sherry A. McKee, Ph.D., reported at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants were male and female non-treatment seeking, nondependent heavy drinkers who also were daily smokers, said Dr. McKee of Yale University, New Haven, Conn.

Subjects were titrated to steady-state levels of varenicline (2 mg/day) or placebo over the course of a week. On day 8, all participants were given free access to cigarettes and were administered a priming drink, which was designed to raise blood alcohol levels to 0.03 g/dL.

Subjective and psychological responses to alcohol were then assessed. A 2-hour period of self-administration followed, during which time participants could choose to consume up to eight additional drinks (designed to raise blood alcohol levels by 0.015 g/dL) or to receive monetary reinforcement for drinks not consumed.

Participants had to have smoked at least 10 cigarettes/day for the last year. Men had to consume more than 14 drinks/week or 5 or more drinks on one occasion; women had to consume more than 7 drinks/week or 4 or more drinks on one occasion. Urine testing was used to assess varenicline compliance on days 4-8.

A total of 20 participants were enrolled–10 in each arm. The groups were matched in terms of age, gender, number of cigarettes per day, weekly frequency of drinking, and the number of drinks per episode.

During the period of unrestricted access to alcohol, varenicline “significantly reduced drinking by about two drinks,” Dr. McKee said.

Two subjects in the varenicline group consumed drinks, compared with seven in the placebo group. After the priming drink, no difference was found in blood alcohol levels between the two groups. However, a significant difference was found in alcohol craving. Those on varenicline reported a sharp decrease in alcohol craving; those on placebo reported an increase.

Over the same time period, the subjective effects of alcohol remained steady for those in the varenicline group but increased in the placebo group. The difference was statistically significant. There was no effect of varenicline on tobacco craving in this period.

There was also no effect of varenicline on physiologic reactivity as measured by diastolic/systolic blood pressure. In terms of smoking, over the treatment period, the number of cigarettes per day decreased by 1.5 cigarettes in the varenicline group, compared with 0.5 in the placebo group.

Adverse events were few and included nausea, sleep disturbance, abnormal dreams, constipation, and vomiting.

Notably, subjects in neither group were able to discern whether they were on placebo or active drug. In the varenicline group, 60% thought that they were on placebo, and in the placebo group, 44% thought they were taking the active drug.

Alcohol and tobacco dependence are highly comorbid disorders. Preclinical evidence suggests a role for nicotinic acetylcholine receptors in alcohol drinking. In fact, the drug has demonstrated efficacy in reducing alcohol intake in animals. However, to date the effects of the drug on alcohol consumption has not been tested in humans.

The results, in addition to findings from animal studies, support a role for nicotinic receptor involvement in alcohol consumption and suggest that targeting nicotinic receptors might be a viable strategy for drug development, said Dr. McKee, who had no conflicts of interest to report.

WASHINGTON – The antismoking drug varenicline also appears to curb alcohol cravings in smokers who are heavy drinkers, results of a small pilot study show.

Nondependent heavy drinkers taking varenicline (Chantix) were more likely to be abstinent during the 2-hour period of free access to alcoholic drinks than were those in the placebo group, based on logistic regression analysis, Sherry A. McKee, Ph.D., reported at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants were male and female non-treatment seeking, nondependent heavy drinkers who also were daily smokers, said Dr. McKee of Yale University, New Haven, Conn.

Subjects were titrated to steady-state levels of varenicline (2 mg/day) or placebo over the course of a week. On day 8, all participants were given free access to cigarettes and were administered a priming drink, which was designed to raise blood alcohol levels to 0.03 g/dL.

Subjective and psychological responses to alcohol were then assessed. A 2-hour period of self-administration followed, during which time participants could choose to consume up to eight additional drinks (designed to raise blood alcohol levels by 0.015 g/dL) or to receive monetary reinforcement for drinks not consumed.

Participants had to have smoked at least 10 cigarettes/day for the last year. Men had to consume more than 14 drinks/week or 5 or more drinks on one occasion; women had to consume more than 7 drinks/week or 4 or more drinks on one occasion. Urine testing was used to assess varenicline compliance on days 4-8.

A total of 20 participants were enrolled–10 in each arm. The groups were matched in terms of age, gender, number of cigarettes per day, weekly frequency of drinking, and the number of drinks per episode.

During the period of unrestricted access to alcohol, varenicline “significantly reduced drinking by about two drinks,” Dr. McKee said.

Two subjects in the varenicline group consumed drinks, compared with seven in the placebo group. After the priming drink, no difference was found in blood alcohol levels between the two groups. However, a significant difference was found in alcohol craving. Those on varenicline reported a sharp decrease in alcohol craving; those on placebo reported an increase.

Over the same time period, the subjective effects of alcohol remained steady for those in the varenicline group but increased in the placebo group. The difference was statistically significant. There was no effect of varenicline on tobacco craving in this period.

There was also no effect of varenicline on physiologic reactivity as measured by diastolic/systolic blood pressure. In terms of smoking, over the treatment period, the number of cigarettes per day decreased by 1.5 cigarettes in the varenicline group, compared with 0.5 in the placebo group.

Adverse events were few and included nausea, sleep disturbance, abnormal dreams, constipation, and vomiting.

Notably, subjects in neither group were able to discern whether they were on placebo or active drug. In the varenicline group, 60% thought that they were on placebo, and in the placebo group, 44% thought they were taking the active drug.

Alcohol and tobacco dependence are highly comorbid disorders. Preclinical evidence suggests a role for nicotinic acetylcholine receptors in alcohol drinking. In fact, the drug has demonstrated efficacy in reducing alcohol intake in animals. However, to date the effects of the drug on alcohol consumption has not been tested in humans.

The results, in addition to findings from animal studies, support a role for nicotinic receptor involvement in alcohol consumption and suggest that targeting nicotinic receptors might be a viable strategy for drug development, said Dr. McKee, who had no conflicts of interest to report.

WASHINGTON – The antismoking drug varenicline also appears to curb alcohol cravings in smokers who are heavy drinkers, results of a small pilot study show.

Nondependent heavy drinkers taking varenicline (Chantix) were more likely to be abstinent during the 2-hour period of free access to alcoholic drinks than were those in the placebo group, based on logistic regression analysis, Sherry A. McKee, Ph.D., reported at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants were male and female non-treatment seeking, nondependent heavy drinkers who also were daily smokers, said Dr. McKee of Yale University, New Haven, Conn.

Subjects were titrated to steady-state levels of varenicline (2 mg/day) or placebo over the course of a week. On day 8, all participants were given free access to cigarettes and were administered a priming drink, which was designed to raise blood alcohol levels to 0.03 g/dL.

Subjective and psychological responses to alcohol were then assessed. A 2-hour period of self-administration followed, during which time participants could choose to consume up to eight additional drinks (designed to raise blood alcohol levels by 0.015 g/dL) or to receive monetary reinforcement for drinks not consumed.

Participants had to have smoked at least 10 cigarettes/day for the last year. Men had to consume more than 14 drinks/week or 5 or more drinks on one occasion; women had to consume more than 7 drinks/week or 4 or more drinks on one occasion. Urine testing was used to assess varenicline compliance on days 4-8.

A total of 20 participants were enrolled–10 in each arm. The groups were matched in terms of age, gender, number of cigarettes per day, weekly frequency of drinking, and the number of drinks per episode.

During the period of unrestricted access to alcohol, varenicline “significantly reduced drinking by about two drinks,” Dr. McKee said.

Two subjects in the varenicline group consumed drinks, compared with seven in the placebo group. After the priming drink, no difference was found in blood alcohol levels between the two groups. However, a significant difference was found in alcohol craving. Those on varenicline reported a sharp decrease in alcohol craving; those on placebo reported an increase.

Over the same time period, the subjective effects of alcohol remained steady for those in the varenicline group but increased in the placebo group. The difference was statistically significant. There was no effect of varenicline on tobacco craving in this period.

There was also no effect of varenicline on physiologic reactivity as measured by diastolic/systolic blood pressure. In terms of smoking, over the treatment period, the number of cigarettes per day decreased by 1.5 cigarettes in the varenicline group, compared with 0.5 in the placebo group.

Adverse events were few and included nausea, sleep disturbance, abnormal dreams, constipation, and vomiting.

Notably, subjects in neither group were able to discern whether they were on placebo or active drug. In the varenicline group, 60% thought that they were on placebo, and in the placebo group, 44% thought they were taking the active drug.

Alcohol and tobacco dependence are highly comorbid disorders. Preclinical evidence suggests a role for nicotinic acetylcholine receptors in alcohol drinking. In fact, the drug has demonstrated efficacy in reducing alcohol intake in animals. However, to date the effects of the drug on alcohol consumption has not been tested in humans.

The results, in addition to findings from animal studies, support a role for nicotinic receptor involvement in alcohol consumption and suggest that targeting nicotinic receptors might be a viable strategy for drug development, said Dr. McKee, who had no conflicts of interest to report.