I saw this story on GMA this morning - The doctor for the drug company said we have to keep in mind alcohol also causes violent behavior.

I guess the other question is, if it is the drug-alcohol interaction (and that would be my guess, though I'm not a doctor, because it seems like almost all psychiatric drugs interact poorly with alcohol), was the musician warned at all about the possibly harmful effects of mixing alcohol with the drug? I know I've been warned about that with all the drugs I've taken, including Lamictal, lithium, Geodon, Abilify, and Zoloft. If he wasn't, then that's negligence on the part of the drug company (who should have figured out the interaction, and who should have put that in the literature about the drug) and/or the doctor, who should have warned him. If he was warned, either in the drug literature or by his doctor, then the negligence is most likely his, unless the drug induced some sort of mania which caused him to drink. If that's the case, or if his behavior was solely drug-induced mania unaffected by the alcohol, then that's negligence of the drug company for failing to catch that in clinical trials.

...Wow, that was a rather lengthy and exhaustive comment. I hope that wasn't too confusing.

Clearly interaction with alcohol.. This must be the very first rule when taking any kind of drugs.

Chantix is different from an SSRI in its pharmacological activity. It is primarily a selective nicotinic receptor partial agonist, and this is thought to account for its efficacy in smoking cessation. Although the Ki values aren't in the NIMH Psychoactive Drug Screening Program database, the PI sheet does suggest that the drug has moderate affinity for the 5-HT3 subtype of serotonin receptor, which is unrelated to all other subtypes. (The other subtypes are G protein coupled receptors, while 5-HT3 is a ligand-gated ion channel.) 5-HT3 is primarily linked with nausea, not with psychoactive effects, so it's unlikely that this activity would contribute to the musician's behavior. Furthermore, this musician was certainly not exhibiting prototypical SSRI-induced suicidal behavior. While it is quite possible his behavior was drug-induced, more information is necessary before we can point a finger at Pfizer.

Chantix got a priority review from the FDA, shortening the application review process from 10 months to 6 months. Given that psychoactive medications often have side effects that don't become evident until years after the drug is made available, perhaps this isn't such a good idea.

i agree. when someone starts a new med--esp an ssri-ish drug--then they must be very very careful about alc intake until they know what they are dealing with. it's sad to me that whomever rx'd this guy's chantix apparently failed to do so. while the doc has a point about booze causing violent behavior, i tend to discount that in light of the fact the guy was an experienced drinker--as almost every musician on the planet is--and didn't have a trakc record of bad booze-related incidents.

this tragedy could have been avoided.

This guy was killed by a gun. A gun. No black box warning can stop a bullet. I wouldn't be safe AROUND a gun, never mind having one pointed at me. Shouldn't this story be about gun control, not SSRIs and evil Big Pharma?

there's no gun control issue here. in the states, we are allowed to own guns and use them to protect our lives and property...and from what i can glean about this situation, it sounds like the shooter had every right to do what he did. tragic all around, but having had my own abode broken into before, i would've done something similar. not that i own a gun. i'm just saying.

off-topic perhaps, but Chantix is nephrotoxic so watch out if you have or might have kidney damage from lithium or diabetes.

Great post. Reminds me of a patient who had a relative who took Ambien and had a couple of drinks then decided he needed to go out and get a pack of cigarets. He started the car and pulled out of the driveway, taking the garage door with him.

His wife had never seen him like that, either. Why aren't the physicians who are prescribing these drugs discussing alcohol? Last I trained, it's considered a substance, too.

I love my new American friends but many seem to have a blind spot when it comes guns:

"there's no gun control issue here. in the states, we are allowed to own guns and use them to protect our lives and property...."

I know Americans like to carry guns. I'm suggesting that you should consider this a gun control issue anyway because the poor guy died from a bullet (or more), not Chiantix. I'm not an apologist for Big Pharma, just alarmed at your unwillingness to question your gun policy.

We know that guns are often used for suicide, that people get killed accidentally, that protecting property isn't worth taking a life, and that the USA's staggering crime and incarceration rate has a lot to do with guns.

(If anyone from the NRA reads this, please don't come up here and try to shoot me. We keep other, safer means of protection around the house.)

Francesca, Unless someone re-writes the Constitution, gun ownership won't change here. The drug-alcohol connection is a major health alert, and the actions as a result of that mix, is what killed the musician.He could have very well been stabbed, punched, ran over by a car, the point is, his behavior was wild, erratic and he was on booze and pills. A common reason people have domestic violence, trash hotel rooms, end up in the ER.
Doctors DO need to tell patients to stop or monitor alcohol intake esp when trialing a new drug. The pharmacy labels that they stick on the bottles don't do enough to warn patients--though they are there.

I'm dropping the gun debate here because this isn't the forum for an argument about Constitutional interpretation. I'll just say that I disagree with you. On the autopsy report it most likely says that he died of a gunshot wound and, without a gun, that wouldn't have happened. I'm afraid of guns and I know, for sure, that I would have died of suicide by gun if I lived in the USA. That seems to me a compelling reason not to have a gun.

I agree that doctors have an obligation to tell their patients about drug risks, but they don't. In my entire career as a mental health consumer, no doctor has even mentioned tardive dyskinesia to me and I used to take a LOT of antipsychotics. From my own observation, it seems that smokers are less likely to get TD or perhaps they can no longer smoke because they're too twitchy. Oliver Sacks (neurologist, author) wrote that nicotine appears to help some kinds of neurological disorders.

Many people have noticed how much smoking occurs in mental hospitals. Are patients self-medicating? Or is it because there is fuck all else to do in the loony bin? These are questions that neurology can answer, if they want to. I try to remember that neurology is a science while psychiatry is not. Science provides answers.

So, since patients obviously aren't being told, it's up to them to find out information in other ways. I thought that was what this blog was all about -- spreading information. Here's some more:

Valenstein's "Blaming the Brain" is really worth a read. He's a neurologist and has no vested interest in the drug debate either way. He explains that SSRIs aren't really the quantum leap that Big Pharma pretends they are -- they're actually a chemical subset of the old tricyclics we all used to hate. Effectiveness is about the same while side effects (the minor ones, anyway) are diminished. Valenstein doesn't comment on SSRI-induced craziness but Grace Jackson ("A Guide to Informed Consent") deals with it extensively.

Gary Greenberg ("Manufacturing Depression" in a recent issue of Harpers Magazine) wrote, in a footnote, that one researcher estimates that the placebo effect might account for a ridiculously high percentage of improvement attributed to drugs. For me, SSRIs were miraculous and tricyclics sucked. So, in this study, where "n=1", SSRIs won.

Here are some things you can find out for yourself without even consulting a doctor: Alcohol almost always makes things worse. Drugs can make you crazy. You can't always trust your neighbours. Guns kill people. These are all lessons that can be learned without the benefit of medical science. I don't want to learn all of them -- my neighbours are awesome and wouldn't shoot me, even if I were trespassing. If I showed up at their place acting crazy, they'd invite me in for tea and try to talk me down. That's the benefit of making connections with your neighbours, which is hard to do sometimes in an urban environment, and part of the reason I moved out to the sticks, one of the most effective mental health decisions I ever made.

Francesca,

This tragic story has a social ill for everyone: guns, alcohol, rock music, funky drugs that no one understands, with hinky promo materials, and yet, there's one interesting point that Michael Moore gave credence in an ADHD documentary post Bowling for Columbine, American's acess to guns is decreasing while gun violence is increasing, and gun violence these days is much more likely to involve behavior mod drugs than not.

As a medical provider who has prescribed a LOT of Chantix... this stuff works. No serious side effects reportd by over 50 patients treated. All but one quit smoking. These are probably better results than what the initial studies have reported, but from first hand experience, this stuff helps smokers quit better than anything else out there. I can cite all kinds of serious side effects with the other most popular smoking cessation meds: Zyban and Nicotine replacement. I also can say with certainty that smoking leads to heart disease and a host of cancers. Unless someone can produce some real scientific evidence that Chantix is a dangerous drug (bad dreams are not serious side effects), the benefits far outweigh the risks. Just my 2 cents.

I smoked for 5 years since I was 16. I was up to 1.5 packs per day. My Doctor prescribed Chantix and I was able to quit the first day I took it. By day 5 I stopped taking the drug as well. I didn't feel I needed it. I had no desire to smoke. I did get a little edgy but it wasn't too bad.My Doctor did not warn me not to drink alcohol when taking the drug but that's a no brainer to me. Most people know that when taking new medication you should read your package insert the pharmacy gives you, or consult with your Doctor. I would recommend Chantix to anyone that wants to quit smoking. The only thing is they recommend you take the drug for 3 months I think if you can stop taking the drug way before then.

JOE, most people don't read fine print or think about booze as a no-brainer.Good thing you got it together.

Since starting taking chantix, I have found that not only do I not crave the cigarettes, but I also do not crave alcohol either. A family member is also experiencing the same. My belief is that everyone reacts different to medicine, and so far I am very pleased!

I'm currently taking Chantix...on day eight. I can tell you that the leader of our smoking cessation class recommended for us NOT to set a quit date, but to smoke until it became repulsive. I'm just about there. I light one up, and put it out. Just not enjoyable. The dreams..oh, yes. I look forward to going to sleep as I dream full-length movies (it seems like) and I remember them. Only once did I wake up because I was startled by the dream. News that this may cause violence concerns me a little, but I don't drink, and my physician instructed me NOT to take the ambien that I have for the occasional sleepless night. The benefits outweigh the risks and I can't wait til I can finally declare that I'm a NON-SMOKER!

My concern is for the Soldiers returning from the Middle East and would like to quit smoking.
They go to the Doctor and off they go with their
CHANTIX fix.
6 Months later The Middle East once again calls their names to serve. They go with their weapon as their companion;
BRAVE, BOLD & full of Andrenaline.
Who would of thought about the Aggresion, Suicidal Thoughts Depression Ect..........
What has happened to my Battle, Friend, Husband,
Son, Daughter, Brother, Sister, and all that were not mentioned.

Is Pfizer getting approval from the FDA for medications and Drugs that are not properly tested before placing them on the market?
Does MONEY GREED & POWER come into play?
A world known company begining to collapse.
Maybe!
You be the Judge.
Wheres the INTEGRITY & TRUST.
CHANTIX EXUBERA LIPITOR
Whats next?

Can you overdose your nero-transmitters while taking Chantix and what long term side effects will occur?
We are all unique individuals.
Our smoking habits are different our lives are different our weights are different. We absorb chemicals and medications differently.
I work around HAZARDOUS CHEMICALS.
Some of the employees have to take URINE tests to regulate the chemical that is absorbed into their bodies to make sure there is no harm to their kidneys. If their URINE test is high then they take a BLOOD test. If that comes back high then THEY ARE NOT placed on a down line until their levels return to normal. PPE is ALWAYS used when dealing with this Chemical. For some of us that don't matter. The test will still come back high.
This is called unique individualism, Genetics,and drinking to much alcohol can cause your levels to be high with this chemical. Since taking Chantix I feel dehydrated and many other symptoms that seem to linger as days go by. I haven't taken this since April and I'm still not normal.
Whats normal to me anyway.
We can't keep taking other drugs to cure the side effects of another drug LIKE CHANTIX.
Maybe there are people that like to take drugs and spend money on all these antidepressants.
In order for you to be able to take Chantix some of you are also taking an antidepressant and changing that two or three times until you find something that works. THAT CAN'T BE GOOD FOR YOU.
I refuse to give the Health Care Facilities and Pharmaceutical Companies all my money. ITS ONE HELL OF A SCARY GAME OF RUSSIAN ROULETTE.
I took Zoloft for two weeks after the fact of taking Chantix.
If you think I'm bad now things were lots lots worse while taking the Zoloft.
You don't give a high speed person a downer.
It almost took my soul away.

Talking about taking your soul away, since taking the Chantix I dont have a soul. Just an empty space were my soul once was. The depression is getting so bad, its worse every day Im in a constant state of panic.cant get anyone to help, I guess the doctors dont want to get into trouble for perscribing this crap. I dont smoke anymore and Im happy about that. But now I and a lot of people like me believe we have brain damage from this medication. My life is a living hell. If anyone has been helped with their depression and panic attacks, please let me know what it is. Cant go on like this much longer, need somekind of help soon. We have got to band together and stop them from giving out this medication that has hurt so many people.I would be thankful for any comments.

4 Days to go till my Champix is finished.



I have been quit for 2 Months, 3 Weeks, 5 Days, 7 hours, 7 minutes and 53 seconds (86 days). I have saved $455.64 by not smoking 1,035 cigarettes. I have saved 3 Days, 14 hours and 15 minutes of my life. My Quit Date: 4/01/2008 1:00 AM.



Interesting to read about the adverse effects of alcohol while taking Champix. Since I started on the tablets not only have they stopped my craving for cigarettes but also for alcohol! Have had exactly two drinks in the past 3 months and they were half full glasses of wine which I did not enjoy. I have been drinking lots of water though.



So, no depression, no moodswings, no getting stuck into my neighbours! My wild technicolor dreams early on have all but ended and yes, my sleep is a little restless but I put it to taking the second tablet in the evening with dinner. I get better sleep if I take it late afternoon with a light snack.



Champix may "not be good for you" and yes, some people on Champix may have comitted suicide but don't forget depression and bi polar are strongly associated with smokers.



http://psychcentral.com/library/depression_smoking.htm



Cigarettes have killed many more people than Champix ever will and if you don't die you have ongoing health problems for most of your life which are both a physical and financial burden to family, friends and health resources.



Smoking is the single greatest cause of death and disease in Australia. According to the 2001 National Drug Strategy Household Survey [Australian Institute of Health and Welfare] tobacco use caused 19,000 deaths and 142,500 hospital episodes were attributed to tobacco smoking.



Smoking is a key risk factor for the three diseases that cause most deaths in Australia: ischaemic heart disease, cerebrovascular disease and lung cancer. It is responsible for around 80% of all lung cancer deaths and 20% of all cancer deaths (smoking has been linked to cancers of the mouth, bladder, kidney, stomach and cervix, among others).



Smokers are also at increased risk of developing chronic obstructive pulmonary disease and reduced lung function and smoking in pregnancy increases the risk of health problems for both mother and child. Tobacco use has been linked to a variety of other conditions, such as diabetes, peptic ulcers, some vision problems, and back pain.



And hey, if you don't believe me, merrily smoke away, forget about a 3 month Champix course which may or may not make you feel a bit down but help you give up cigarettes and enjoy this video:



http://youtube.com/watch?v=-DbFBu_I_lA