COMMENTARY

Smoking and Seizures: Where the Evidence Stands

Andrew N. Wilner, MD

Disclosures

November 03, 2015

Seizure Risks of Smoking Cessation Drugs

Recent postmarketing data submitted to the US Food and Drug Administration (FDA) on varenicline (Chantix®), a popular prescription smoking-cessation medication, found that it may cause seizures in people without epilepsy or trigger seizures in people with well-controlled seizures.[4] In addition, varenicline may lower tolerance to alcohol and cause patients to experience increased drunkenness, unusual or aggressive behavior, and memory loss. Prior reports on varenicline have focused on potentially serious neuropsychiatric side effects. Varenicline joins bupropion (Zyban®) and nicotine replacement as FDA-approved methods for smoking cessation.[5] These other two agents have also been associated with increased seizure risk. Bupropion has been associated with seizures after overdose,[6] and case reports support that seizures may result from poisoning with multiple transdermal nicotine patches.[7]

Take-Home Points

People with epilepsy are just as likely to smoke as people without epilepsy. The effect of cigarette smoking on seizure risk in people with epilepsy is unknown. Cigarette smoking may increase the risk for seizures in those without epilepsy. The autonomic, cardiac, and pulmonary toxicities of cigarette smoking raise theoretical concerns regarding an etiopathologic association with SUDEP.

Given that there are no known health benefits of cigarette smoking, people with epilepsy should be aggressively counseled to stop. However, an increased risk for seizures related to bupropion and varenicline must be considered when considering smoking cessation in people with epilepsy. Because it is difficult to stop smoking, people who wish to optimize their health should be discouraged from initiating cigarette smoking and its lifetime of harmful effects.

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