Translation of a-t 2019; 50: 47
 

CURRENT ADR NETWORK REPORT

Severe acne during treatment with varenicline (CHAMPIX)

A 37-year-old man has been taking varenicline (CHAMPIX) to help him stop smoking after over 20 years of nicotine consumption. Shortly after the start of use, in addition to psychiatric and hormonal adverse effects such as sleeplessness, mood swings and depression (see e a-t 5/2016b and others), loss of libido and erectile dysfunction that are known for the substance (1), the patient developed severe acne. Numerous inflamed follicular papules and pustules spread over the patient's face, head, chest and upper back. While the psychic and sexual impairments improved three weeks after the end of the overall six week treatment with the partial nicotine receptor agonist, the skin symptoms persisted and required treatment with isotretinoin per os (AKNENORMIN and other generics) and local treatment with benzoyl peroxide (AKNEFUG OXID and other generics; NETZWERK report 17.677). The Summary of Product Characteristics (SPC) for varenicline (1) mentions occasionally occuring acne as a possible adverse effect. The possibly severe extent of this is not, however, addressed. In the literature, we find a further report of severe papulopustular acne with itching in a 32 year-old woman after taking varenicline to stop smoking for around a month and a half (2). Unlike acne vulgaris, drug-induced acne normally presents with papules and pustules that can spread over large areas and affect non-standard areas. Comedones normally do not occur at the start. The pathomechanism is often not known (3). Other severe skin reactions have been described in patients taking varenicline, including STEVENS-JOHNSON syndrome and erythema multiforme (1) (a-t 2008; 39: 72).

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