Can Varenicline Be Safely Used with Anxiety Medications?

Taking Varenicline for smoking cessation while also using anti-anxiety medication?

Hello, I have been undergoing treatment in psychiatry for two years due to autonomic nervous system dysfunction and depression.
Currently, I take 3 mg of Lurasidone and 25 mg of Venlafaxine every night.
A week ago, I started treatment at a smoking cessation clinic and have been taking 150 mg of Bupropion twice daily.
After one week of medication, I attempted to quit smoking (using e-cigarettes), but on the first day of complete cessation, I experienced chest tightness, hand tremors, and noticeable heart palpitations.
I would like to ask: 1.
Is it safe to use Bupropion together with Lurasidone and Venlafaxine? 2.
Are the symptoms I experienced on the first day of complete cessation withdrawal symptoms or side effects of Bupropion? Thank you.

Xiao Hei, 40~49 year old female. Ask Date: 2021/09/30

Dr. Zhang Gengjia reply Psychiatry

Dear Sir/Madam,
From your letter, it is clear that you are experiencing discomfort and distress due to the pressures of both depression and autonomic nervous system dysregulation.

1.
Facing an uncertain future, psychosomatic disorders are common in modern society.
This is a chronic condition that requires long-term treatment for recovery.
Tobacco and nicotine have adverse effects on both physical and mental health.
I wish you success in quitting smoking soon.
2.
Psychosomatic disorders are chronic illnesses characterized by episodes of exacerbation, remission, recovery, and relapse.
More than half of patients may experience a recurrence of symptoms even after they have improved.
Due to individual differences in physiology, it may take time to determine the most suitable medication, and it is not possible to simply attribute which medication is more effective.
Please be patient and cooperate with your physician.
3.
Regarding pharmacological treatment, each primary medication requires 4 to 6 weeks to assess its efficacy.
I recommend that if you experience any adverse symptoms, you should note the medication dosage, duration, and frequency of occurrences.
4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, anesthesia-free, highly safe treatment that does not require hospitalization.
It can improve anxiety and depressive moods.
For patients with treatment-resistant depression or poor medication response, significant improvement in depressive symptoms can be observed after rTMS treatment.
Please discuss your psychosomatic issues thoroughly with your physician during your follow-up appointment, as some symptoms may be related to the original condition, while others may be side effects of the medication.
Our clinic is open for consultations from Monday to Friday, both in the morning and afternoon.
I recommend that you consider visiting the clinic for a personal evaluation of your symptoms, so we can collaboratively determine the best course of action for you.
Wishing you mental and physical well-being.
Sincerely,
Dr.
Chang Geng-Jia
Department of Psychiatry

Reply Date: 2021/09/30

More Info

When considering the use of Varenicline (commonly known as Chantix) alongside anxiety medications such as Lurasidone (Lusidone) and Venlafaxine (Effexor), it is essential to understand both the pharmacological interactions and the potential side effects that may arise from this combination.

1. Safety of Combining Varenicline with Anxiety Medications:
Varenicline is primarily used as a smoking cessation aid. It works by stimulating nicotine receptors in the brain, which helps reduce withdrawal symptoms and cravings associated with quitting smoking. Lurasidone is an atypical antipsychotic often used to treat mood disorders, while Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) used for depression and anxiety disorders.
Generally, there are no direct contraindications for using Varenicline with Lurasidone and Venlafaxine. However, both Lurasidone and Venlafaxine can have side effects that may overlap with those of Varenicline, such as increased anxiety, agitation, or changes in mood. It is crucial to monitor for any exacerbation of anxiety symptoms or other psychiatric effects when these medications are combined.
It is advisable to consult your healthcare provider before making any changes to your medication regimen. They can provide personalized guidance based on your medical history and current health status.

2. Understanding Withdrawal Symptoms vs. Side Effects:
The symptoms you experienced on the first day of quitting smoking—such as chest tightness, tremors, and increased heart rate—can be attributed to both withdrawal symptoms and potential side effects of Varenicline. When a person stops smoking, they may experience withdrawal symptoms due to the absence of nicotine, which can include irritability, anxiety, restlessness, and physical symptoms like tremors or increased heart rate.

Varenicline can also cause side effects, including nausea, insomnia, and changes in mood or behavior. The onset of these symptoms can vary from person to person. It is essential to differentiate between withdrawal symptoms and side effects, as both can impact your overall well-being during the cessation process.

If you find that your symptoms are severe or persistent, it is crucial to reach out to your healthcare provider. They can help determine whether these symptoms are more likely related to withdrawal or the medication itself and can adjust your treatment plan accordingly.

3. Additional Considerations:
When undergoing treatment for anxiety and depression while attempting to quit smoking, it is vital to have a comprehensive support system in place. This may include counseling, support groups, or behavioral therapies that can complement your medication regimen.
Additionally, lifestyle modifications such as regular exercise, a balanced diet, and mindfulness practices can significantly aid in managing anxiety and withdrawal symptoms.
In conclusion, while Varenicline can generally be used safely with anxiety medications like Lurasidone and Venlafaxine, close monitoring for any adverse effects or increased anxiety is essential. If you experience significant symptoms, consult your healthcare provider for tailored advice and support. Quitting smoking is a challenging process, but with the right support and management, it can lead to improved mental and physical health outcomes.

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